Abstract
Objectives
Both mindful breathing and deep diaphragmatic breathing are used in the treatment of emotional disorders and can help people learn to modulate the body’s stress response. While both result in deep, slow breathing, the two approaches are quite different in their origins. We tested whether individual differences in spirituality might moderate their efficacy.
Methods
Forty-eight undergraduates from the University of Pennsylvania completed baseline measures of spirituality as well as respiration rate, tidal volume and heart rate variability (HRV) at rest. Participants were then randomly assigned to a video that guided them through a mindful breathing exercise (which mentioned “a long tradition of meditation style exercises that have been used for literally thousands of years”) (N = 21) or a diaphragmatic breathing exercise (N = 27).
Results
Both types of training resulted in lower respiration rate and higher tidal volume over baseline (all ts > 3.78, ps < 0.001), but only diaphragmatic breathing resulted in significant increases in HRV (t(26) = 6.29, p < 0.001). Spirituality moderated the impact, such that spiritual people benefited equally from both types of breathing training, but less spiritual people benefited more from diaphragmatic breathing than from mindful breathing (F(4,46) = 3.69, p = .06).
Conclusions
These results suggest that spirituality may moderate the impact of mindfulness-based interventions (MBIs) in the American context. Discussion focuses analyzes how our results may reflect a misunderstanding of eastern wisdom traditions as they were characterized during colonial times.
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References
Ahles, J. J., Mezulis, A. H., & Hudson, M. R. (2016). Religious coping as a moderator of the relationship between stress and depressive symptoms. Psychology of Religion and Spirituality, 8(3), 228–234.
Arch, J. J., & Ayers, C. R. (2013). Which treatment worked better for whom? Moderators of group cognitive behavioral therapy versus adapted mindfulness based stress reduction for anxiety disorders. Behaviour Research and Therapy, 51(8), 434–442. https://doi.org/10.1016/j.brat.2013.04.004
Arch, J. J., & Craske, M. G. (2006). Mechanisms of mindfulness: Emotion regulation following a focused breathing induction. Behaviour Research and Therapy, 44(12), 1849–1858.
Barber, J. P., & Muenz, L. R. (1996). The role of avoidance and obsessiveness in matching patients to cognitive and interpersonal psychotherapy: Empirical findings from the treatment for depression collaborative research program. Journal of Consulting and Clinical Psychology, 64(5), 951–958. https://doi.org/10.1037/0022-006X.64.5.951
Berntson, G. G., & Stowell, J. R. (1998). ECG artifacts and heart period variability: Don’t miss a beat! Psychophysiology, 35(1), 127–132.
Brown, C. G. (2016). Can “secular” mindfulness be separated from religion? In R. Purser, D. Forbes, & A. Burke (Eds.), Handbook of mindfulness (pp. 75–94). Springer International Publishing.
Chadha, M. (2015). A Buddhist epistemological framework for mindfulness meditation. Asian Philosophy, 25(1), 65–80.
Chen, Y. F., Huang, X. Y., Chien, C. H., & Cheng, J. F. (2017). The effectiveness of diaphragmatic breathing relaxation training for reducing anxiety. Perspectives in Psychiatric Care, 53(4), 329–336.
Cho, H., Ryu, S., Noh, J., & Lee, J. (2016). The effectiveness of daily mindful breathing practices on test anxiety of students. PLoS ONE, 11(10), e0164822. https://doi.org/10.1371/journal.pone.0164822
Chorpita, B. F., Daleiden, E. L., & Weisz, J. R. (2005). Modularity in the design and application of therapeutic interventions. Applied and Preventive Psychology, 11(3), 141–156. https://doi.org/10.1016/j.appsy.2005.05.002
Cohen, S. (2019). The ancient connections between atheism, Buddhism and Hinduism. Quartz India. https://qz.com/india/1585631/the-ancient-connections-between-atheism-buddhism-and-hinduism/
Colgan, D. D., Christopher, M., Michael, P., & Wahbeh, H. (2016). The body scan and mindful breathing among veterans with PTSD: Type of intervention moderates the relationship between changes in mindfulness and post-treatment depression. Mindfulness, 7(2), 372–383. https://doi.org/10.1007/s12671-015-0453-0
Collard, P., Avny, N., & Boniwell, I. (2008). Teaching mindfulness based cognitive therapy (MBCT) to students: The effects of MBCT on the levels of mindfulness and subjective well-being. Counselling Psychology Quarterly, 21, 323–336.
Cullen, M. (2011). Mindfulness-based interventions: An emerging phenomenon. Mindfulness, 2(3), 186–193.
Dishman, R. K., Nakamura, Y., Garcia, M. E., Thompson, R. W., Dunn, A. L., & Blair, S. N. (2000). Heart rate variability, trait anxiety, and perceived stress among physically fit men and women. International Journal of Psychophysiology, 37, 121–133.
Eberth, J., Sedlmeier, P., & Schäfer, T. (2019). PROMISE: A model of insight and equanimity as the key effects of mindfulness meditation. Frontiers in Psychology, 10, 2389. https://doi.org/10.3389/fpsyg.2019.02389
Gosch, E. A., Flannery-Schroeder, E., Mauro, C. F., & Compton, S. N. (2006). Principles of cognitive-behavioral therapy for anxiety disorders in children. Journal of Cognitive Psychotherapy, 20(3), 247–262.
Gould, L. F., Dariotis, J. K., Mendelson, T., & Greenberg, M. T. (2012). A school-based mindfulness intervention for urban youth: Exploring moderators of intervention effects. Journal of Community Psychology, 40(8), 968–982. https://doi.org/10.1002/jcop.21505
Greenberg, J. (2006). Comprehensive stress management. McGraw-Hill Education.
Greeson, J. M., Smoski, M. J., Suarez, E. C., Brantley, J. G., Ekblad, A. G., Lynch, T. R., & Wolever, R. Q. (2015). Decreased symptoms of depression after mindfulness-based stress reduction: Potential moderating effects of religiosity, spirituality, trait mindfulness, sex, and age. The Journal of Alternative and Complementary Medicine, 21(3), 166–174. https://doi.org/10.1089/acm.2014.0285
Grossman, P. (1983). Respiration, stress, and cardiovascular function. Psychophysiology, 20(3), 284–300.
Harvey, J. (1978). Diaphragmatic breathing: A practical technique for breath control. The Behavior Therapist, 1, 13–14.
Hayes, S. C., & Hofmann, S. G. (2017). The third wave of cognitive-behavioral therapy and the rise of process-based care. World Psychiatry, 16(3), 245–246.
Hazlett-Stevens, H., & Craske, M. G. (2009). Breathing retraining and diaphragmatic breathing techniques. In ODonohue, W. T. & Fisher, J. E. (Eds.), General principles and empirically supported techniques of cognitive behavior therapy (166-172). New Jersey, NJ: John Wiley & Sons
Highnett, K. (2018). Conservative Christians want to stop kids meditation at school. Newsweek, 12/15/2018. Downloaded from https://www.newsweek.com/mindfulness-meditation-schools-aclj-buddhism-1260323.
Hill, P. C., Pargament, K., II., Hood, R. W., McCullough, Jr., Michael, E., Swyers, J. P., Larson, D. B., & Zinnbauer, B. J. (2000). Conceptualizing religion and spirituality: Points of commonality, points of departure. Journal for the Theory of Social Behaviour, 30(1), 51–77. https://doi.org/10.1111/1468-5914.00119
Howard, V. R. (2017). Dharma: The Hindu, Jain Buddhist and Sikh traditions of India. I.B. Tauris.
Hunt, M., Al-Breiki, F., Dailey, S., Russell, R., & Simon, K. (2017). Mindfulness training, yoga, or both? Dismantling the active components of a mindfulness based stress reduction intervention. Mindfulness, 9(2), 512–520. https://doi.org/10.1007/s12671-017-0793-z
Hunt, M., Rushton, J., Shenberger, E., & Murayama, S. (2018). Positive effects of diaphragmatic breathing on physiological stress reactivity in varsity athletes. Journal of Clinical Sport Psychology, 12(1), 27–38. https://doi.org/10.1123/jcsp.2016-0041
Jain, S., Shapiro, S. L., Swanick, S., Roesch, S. C., Mills, P. J., Bell, I., & Schwartz, G. E. R. (2007). A randomized controlled trial of mindfulness meditation versus relaxation training: Effects on distress, positive states of mind, rumination and distraction. Annals of Behavioral Medicine, 33, 11–21.
Jerath, R., Edry, J. W., Barnes, V. A., & Jerath, V. (2006). Physiology of long pranayamic breathing: Neural respiratory elements may provide a mechanism that explains how slow deep breathing shifts the autonomic nervous system. Medical Hypotheses, 67(3), 566–571.
Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results. General Hospital Psychiatry, 4, 33–47.
Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. Hyperion Books.
Kabat-Zinn, J. (2000, October 7). Mindfulness and the cessation of suffering. Interview by D. Fisher. Retrieved January 4, 2016, from http://www.lionsroar.com/mindfulness-and-the-cessation-of-suffering-an-exclusive-new-interview-with-mindfulness-pioneer-jon-kabat-zinn/
Kabat-Zinn, J. (2002). Commentary on Majumdar et al.: Mindfulness meditation for health. The Journal of Alternative and Complementary Medicine, 8(6), 731–735. https://doi.org/10.1089/10755530260511739
Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156.
Kabat-Zinn, J., Lipworth, L., & Burney, R. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine, 8(2), 163–190.
Kabat-Zinn, J., Lipworth, L., Burney, R., & Sellers, W. (1986). Four year follow-up of a meditation-based program for the self-regulation of chronic pain: Treatment outcomes and compliance. The Clinical Journal of Pain, 2, 159–173.
Kabat-Zinn, J., Massion, A. O., Kristeller, J., & Peterson, L. G. (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. The American Journal of Psychiatry, 149, 936–943.
Kemp, A. H., Quintana, D. S., Felmingham, K. L., Mathews, S., & Jelinek, H. F. (2012). Depression, comorbid anxiety disorders, and heart rate variability in physically healthy, unmedicated patients: Implications for cardiovascular risk. PLoS ONE, 7, e30777.
King, M., Jones, L., Barnes, K., Low, J., Walker, C., Wilkinson, S., Mason, C., Sutherland, J., & Tookman, A. (2006). Measuring spiritual belief: Development and standardization of a Beliefs and Values Scale. Psychological Medicine, 36(3), 417–425. https://doi.org/10.1017/S003329170500629X
Kniffin, T. C., Carlson, C. R., Ellzey, A., Eisenlohr-Moul, T., Beck, K. B., McDonald, R., & Jouriles, E. N. (2014). Using virtual reality to explore self-regulation in high-risk settings. Trauma, Violence, & Abuse, 15(4), 310–321. https://doi.org/10.1177/1524838014521501
Koller, J. M. (1972). Dharma: An expression of universal order. Philosophy of East and West, 22(2), 131–144.
Krishnamurti, J. (1979). The Wholeness of Life. Harper and Row.
Kumar, V., & Kumar, S. (2014). Workplace spirituality as a moderator in relation between stress and health: An exploratory empirical assessment. International Review of Psychiatry, 26(3), 344–351.
Laborde, S., Mosley, E., & Thayer, J. F. (2017). Heart rate variability and cardiac vagal tone in psychophysiological research: Recommendations for experiment planning, data analysis, and data reporting. Frontiers in Psychology, 8, 213. https://doi.org/10.3389/fpsyg.2017.00213
Lambert, M. J. (2011). Psychotherapy research and its achievements. In J. C. Norcross, G. R. VandenBos, & D. K. Freedheim (Eds.), History of psychotherapy (2nd ed.). American Psychological Association.
Lee, B. (2007). Moderating effects of religious/spiritual coping in the relation between perceived stress and psychological well-being. Pastoral Psychology, 55, 751–759.
Licht, C. M. M., de Geus, E. J. C., van Dyck, R., & Penninx, B. W. J. H. (2009). Association between anxiety disorders and heart rate variability in the Netherlands study of depression and anxiety (NESDA). Psychosomatic Medicine, 71, 508–518.
Lutfi, M. F. (2017). The physiological basis and clinical significance of lung volume measurements. Multidisciplinary Respiratory Medicine, 12(1), 3. https://doi.org/10.1186/s40248-017-0084-5
Ma, X., Yue, Z.-Q., Gong, Z.-Q., Zhang, H., Duan, N.-Y., Shi, Y.-T., … Li, Y.-F. (2017). The effect of diaphragmatic breathing on attention, negative affect and stress in healthy adults. Frontiers in Psychology, 8, 874. https://doi.org/10.3389/fpsyg.2017.00874
Maharaj, N. (1973). I Am That, Vols. I and II. Chetana, Bombay. The Acorn Press, Durham, North Carolina.
Mankus, A. M., Aldao, A., Kerns, C., Wright Mayville, E., & Mennin, D. S. (2013). Mindfulness and heart rate variability in individuals with high and low generalized anxiety symptoms. Behaviour Research and Therapy, 51, 386–391.
Medicore. (n.d.). SA-3000P clinical manual (Version 3.0). Retrieved from http://medi-core.com/download/HRV_clinical_manual_ver3.0.pdf
Misra, P. (2002). How the British invested Hinduism. New Statesman. https://www.newstatesman.com/node/156145
Modesti, P. A., Ferrari, A., Bazzini, C., & Boddi, M. (2015). Time sequence of autonomic changes induced by daily slow-breathing sessions. Clinical Autonomic Research, 25(2), 95–104. https://doi.org/10.1007/s10286-014-0255-9
Momtaz, Y. A., Hamid, T., Ibrahim, R., Yahaya, N., & Chai, S. T. (2011). Moderating effect of religiosity on the relationship between social isolation and psychological well-being. Mental Health, Religion & Culture, 14(2), 141–156.
Norcross, J. C. (1991). Prescriptive matching in psychotherapy: An introduction. Psychotherapy: Theory, Research, Practice, Training, 28(3), 439–443. https://doi.org/10.1037/0033-3204.28.3.439
Norcross, J. C., & Wampold, B. E. (2011). What works for whom: Tailoring psychotherapy to the person. Journal of Clinical Psychology, 67(2), 127–132. https://doi.org/10.1002/jclp.20764
Nunan, D., Sandercock, G. R. H., & Brodie, D. A. (2010). A quantitative systematic review of normal values for short-term heart rate variability in healthy adults. Pacing and Clinical Electrophysiology, 33, 1407–1417. https://doi.org/10.1111/j.1540-8159.2010.02841.x
Oman, D., Shapiro, S. L., Thoresen, C. E., Plante, T., & Flinders, T. (2008). Meditation lowers stress and supports forgiveness among college students: A randomized controlled trial. Journal of American College Health, 56, 569–578.
Paul, G., Elam, B., & Verhulst, S. J. (2007). A longitudinal study of students’ perceptions of using deep breathing meditation to reduce testing stresses. Teaching and Learning in Medicine, 19(3), 287–292. https://doi.org/10.1080/10401330701366754
Prinsloo, G. E., Derman, W. E., Lambert, M. I., & Rauch, H. L. (2013). The effect of a single session of short duration biofeedback-induced deep breathing on measures of heart rate variability during laboratory-induced cognitive stress: A pilot study. Applied Psychophysiology and Biofeedback, 38(2), 81–90.
Quintana, D. S., Alvares, G. A., & Heathers, J. A. J. (2016). Guidelines for Reporting Articles on Psychiatry and Heart rate variability (GRAPH): Recommendations to advance research communication. Translational Psychiatry, 6, e803. https://doi.org/10.1038/tp.2016.73
Rama, S., Ballentine, R., & Hymes, A. (2007). Science of breath: A practical guide. The Himalayan Institute Press.
Rodríguez-Liñares, L., Lado, M. J., Vila, X. A., Méndez, A. J., & Cuesta, P. (2014). gHRV: Heart rate variability analysis made easy. Computer Methods and Programs in Biomedicine, 116(1), 26–38. https://doi.org/10.1016/j.cmpb.2014.04.007
Russo, M. A., Santarelli, D. M., & O’Rourke, D. (2017). The physiological effects of slow breathing in the healthy human. Breathe (sheffield, England), 13(4), 289–309.
Shapiro, S. L., Schwartz, G. E., & Bonner, G. (1998). Effects of mindfulness-based stress reduction on medical and premedical students. Journal of Behavioral Medicine, 21, 581–599.
Shearer, A., Hunt, M., Chowdhury, M., & Nicol, L. (2016). Effects of a brief mindfulness meditation intervention on student stress and heart rate variability. International Journal of Stress Management, 23(2), 232–254.
Shonin, E., Van Gordon, W., & Girffiths, M. D. (2013). Mindfulness-based interventions: Towards mindful clinical integration. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2013.00194
Silk, J. A. (1994). The Victorian creation of Buddhism. Journal of Indian Philosophy, 22(2), 171–196. https://doi.org/10.1007/BF01061755
Suzuki, S. (1970). Zen mind, beginner’s mind. Weatherall.
Tarvainen, M. P., Niskanen, J. P., Lipponen, J. A., Ranta-Aho, P. O., & Karjalainen, P. A. (2014). Kubios HRV–heart rate variability analysis software. Computer Methods and Programs in Biomedicine, 113(1), 210–220. https://doi.org/10.1016/j.cmpb.2013.07.024
Task Force of the European Society of Cardiology and The North American Society of Pacing and Electrophysiology. (1996). Heart rate variability: Standards of measurement, physiological interpretation, and clinical use. European Heart Journal, 17, 354–381.
Thera, N. (1962). The heart of Buddhist meditation. Samuel Weiser.
Thera, N. (2001). The power of mindfulness. Sukhi Hotu Sdn Bhd.
Tweeddale, P. M., Rowbottom, I., & McHardy, G. J. R. (1994). Breathing retraining: Effect on anxiety and depression scores in behavioural breathlessness. Journal of Psychosomatic Research, 38(1), 11–21.
Visted, E., Sørensen, L., Osnes, B., Svendsen, J. L., Binder, P. E., & Schanche, E. (2017). The association between self-reported difficulties in emotion regulation and heart rate variability: The salient role of not accepting emotions. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2017.00328
Wampold, B. E. (2001). The great psychotherapy debate: Models, methods and findings. Erlbaum.
Weisz, J. R. (2012). Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: A randomized effectiveness trial. Archives of General Psychiatry, 69(3), 274. https://doi.org/10.1001/archgenpsychiatry.2011.147
Wetherell, J. L., Ayers, C. R., Sorrell, J. T., Thorp, S. R., Nuevo, R., Belding, W., Gray, E., Stanley, M. A., Arean, P. A., Donohue, M., Unützer, J., Ramsdell, J., Xu, R., & Patterson, T. L. (2009). Modular psychotherapy for anxiety in older primary care patients. The American Journal of Geriatric Psychiatry, 17(6), 483–492. https://doi.org/10.1097/JGP.0b013e3181a31fb5
Wolitzky-Taylor, K. B., Arch, J. J., Rosenfield, D., & Caske, M. G. (2012). Moderators and non-specific predictors of treatment outcome for anxiety disorders: A comparison of cognitive-behavioral therapy to acceptance and commitment therapy. Journal of Consulting and Clinical Psychology, 80(5), 786–799.
Yokogawa, M., Kurebayashi, T., Ichimura, T., Nishino, M., Miaki, H., & Nakagawa, T. (2018). Comparison of two instructions for deep breathing exercise: Non-specific and diaphragmatic breathing. Journal of Physical Therapy Science, 3(4), 614–618. https://doi.org/10.1589/jpts.30.614
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MGH designed the study, analyzed the data, and wrote the paper. TR collaborated in the design of the study, in collecting and cleaning the data, and in writing the paper. FC collaborated in the design of the study and in collecting and cleaning the data. MO collaborated in the design of the study and in collecting the data, and performed most of the HRV data cleaning.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional IRB at the University of Pennsylvania and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
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Hunt, M., Rajagopal, T., Cerecino, F. et al. Mindful Versus Diaphragmatic Breathing: Spirituality Moderates the Impact on Heart Rate Variability. Mindfulness 12, 2743–2753 (2021). https://doi.org/10.1007/s12671-021-01738-x
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DOI: https://doi.org/10.1007/s12671-021-01738-x