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The role of deep breathing on stress

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Abstract

The objective of this study was to verify, in a sample of university students, whether a relaxing technique called deep breathing (stress Intervention Functional IFA) is capable to improve the mood and to reduce the levels of stress. Thirty-eight adult healthy subjects (aged between 18 and 28 years) volunteered the study. They were randomly divided in two groups, the Experimental Group (N = 19) and the Control Group (N = 19). The subjects of the Experimental Group were submitted, once per week, to 10 treatment’s sessions of Anti-stress Protocol, each lasting 90 min, whereas subjects of the Control Group sat ten times for 90 min, once per week, without practicing any treatment. The psychological state of mood and stress was evaluated using Measurement of Psychological Stress (MSP) and Profile of Mood State (POMS), while the biological profile of the stress was detected by measuring the heart rate and the salivary cortisol. The results obtained from the present research support the possibility that deep breathing technique is capable to induce an effective improvement in mood and stress both in terms of self-reported evaluations (MPS and POMS) and of objective parameters, such as heart rate and salivary cortisol levels. No statistically significant difference was found between men and women.
ORIGINAL ARTICLE
The role of deep breathing on stress
Valentina Perciavalle
1
Marta Blandini
2
Paola Fecarotta
3
Andrea Buscemi
2
Donatella Di Corrado
4
Luana Bertolo
2
Fulvia Fichera
2
Marinella Coco
2
Received: 13 July 2016 / Accepted: 1 December 2016
ÓSpringer-Verlag Italia 2016
Abstract The objective of this study was to verify, in a
sample of university students, whether a relaxing technique
called deep breathing (stress Intervention Functional IFA)
is capable to improve the mood and to reduce the levels of
stress. Thirty-eight adult healthy subjects (aged between 18
and 28 years) volunteered the study. They were randomly
divided in two groups, the Experimental Group (N=19)
and the Control Group (N=19). The subjects of the
Experimental Group were submitted, once per week, to 10
treatment’s sessions of Anti-stress Protocol, each lasting
90 min, whereas subjects of the Control Group sat ten
times for 90 min, once per week, without practicing any
treatment. The psychological state of mood and stress was
evaluated using Measurement of Psychological Stress
(MSP) and Profile of Mood State (POMS), while the bio-
logical profile of the stress was detected by measuring the
heart rate and the salivary cortisol. The results obtained
from the present research support the possibility that deep
breathing technique is capable to induce an effective
improvement in mood and stress both in terms of self-
reported evaluations (MPS and POMS) and of objective
parameters, such as heart rate and salivary cortisol levels.
No statistically significant difference was found between
men and women.
Keywords Deep breathing Stress Cortisol Emotion
Introduction
Psychological stress is a major risk factor for the devel-
opment and progression of a number of diseases, including
cardiovascular disease, cancer, arthritis, and major
depression [1].
A fact known by the scientific community is that emo-
tions in general, and stress in particular, produce interre-
lated functional changes, mainly through the vegetative
nervous system, the endocrine system and the immune
system.
A protracted state of tension induces in the individual
psychological, physiological and behavioral effects that
over time can lead to harmful consequences [2].
Contemporary society maintains individuals in a con-
stant struggle for success without taking into account their
needs and how much all this costs them. For professional
sportsmen, mood and level of stress have been always
considered aspect they must learn to control. Moreover, it
has reported an increase of alteration of mood states and of
levels of stress in young students [3,4].
The objective of this research is to verify, in a sample of
university students, mood and stress levels, for evaluating
the efficacy of a particular relaxing technique, called deep
breathing (stress Intervention Functional IFA), for amelio-
rating the mood and for returning to normal levels of stress.
In Japan, deep breathing is widely used as a method of
reducing tension and mood. It is a fundamental technique
used in various relaxation methods and is also incorporated
&Marinella Coco
marinella.coco@unict.it
1
Department of Sciences of Formation, University of Catania,
Catania, Italy
2
Department of Biomedical and Biotechnological Sciences,
University of Catania, Via Santa Sofia 64, 95125 Catania,
Italy
3
Functional Psychotherapy Center of Catania, Catania, Italy
4
Faculty of Human and Social Sciences, University ‘‘Kore’’ of
Enna, Enna, Italy
123
Neurol Sci
DOI 10.1007/s10072-016-2790-8
in qigong, yoga and progressive muscle relaxation [5].
However, in that study the evaluation of the effects of the
different relaxation method on mood and stress was carried
out using self-reported evaluations.
In this study, we investigated the effects of deep
breathing on mood and stress not only with self-reported
evaluations but also measuring objective parameters, as
heart rate and salivary cortisol levels. The used self-re-
ported psychological tests were the Measurement of Psy-
chological Stress (MSP) and the Profile of Mood State
(POMS), while the biological profile of the stress was
evaluated by measuring heart rate and levels of salivary
cortisol [6]. This study is intended as a preliminary eval-
uation for a larger intervention study.
Materials and methods
Subjects
Thirty-eight adult healthy subjects, students of the degree
course in Psychology at the University of Catania, volun-
teered the study. Participants aged between 18 and 28 years
and were randomly divided in two groups, with 19 subjects
forming the Experimental Group and the other 19 repre-
senting the Control Group. Written informed consent was
obtained from the subjects.
Protocol
The subjects of the Experimental Group (three males and
16 females with a mean age 23.2 years ±2.74), were
subjected, once per week, to ten treatment sessions of Anti-
stress Protocol (see below), each lasting 90 min at the
Functional Psychotherapy Center of Catania. The treatment
took place between 9 and 11 a.m., and was always prac-
ticed by one of us (P.F.).
The subjects of the Control Group (four males and 15
females with a mean age 23.2 years ±2.46), summoned
ten times, once per week, at the Functional Psychotherapy
Center of Catania, where they sat between 9 and 11 a.m.
for 90 min without practicing any treatment.
At the beginning of the first session (I), fifth session (II)
and tenth session (III) to all 38 participants were admin-
istered MSP and POMS, and was measured heart rate and
salivary cortisone levels.
POMS test
To evaluate quantitatively the mood of the subjects they
had to complete the 30-item Profile of Mood States
(POMS) [7], which is a self-rating questionnaire consisting
of six mood dimensions: Tension–Anxiety (T–A),
Depression–Dejection (D), Anger–Hostility (A–H), Vigor
(V), Fatigue (F), and Confusion (C). The total mood dis-
turbance (TMD) score is calculated by subtracting the
Vscore from the sum of scores for the other dimensions.
MSP test
To describe the variables able to provide a global index of
the state of psychological stress, the Measurement of Psy-
chological Stress (MSP) Scale (Measure du Stress Test
Psychologique [8]) was used in the Italian translation and
adaptation of Di Nuovo and Rispoli [9]. The MSP is a
questionnaire consisting of 49 items based on different
aspects related to the perception that the individual has of its
condition (cognitive-affective, physiological, behavior). The
choice of responses is made of a scale (Likert-type) whose
possible answers are 1–4 (from ‘‘not at all’’ to ‘‘very’’).
Heart rate
Cacioppo and Berntson [10] demonstrated that an increase
in heart rate often associate with the stressors, so we
decided to use as a parameter for the evaluation of heart
rate stress. The heart rate was measured in the Experi-
mental as well as Control Group for 5 min at the beginning
of the first session (I), fifth session (II) and tenth session
(III). Measurement of heart rate started after that the sub-
ject sat for 15 min on a comfortable armchair.
Salivary cortisol
Levels of salivary cortisol were assessed using Radioim-
munoassay Cortisol Test (RIA CT from RADIM), as pre-
viously described [11]. The saliva samples were collected
three times in the same day (30 min after awakening and at
14:00 and 20:00 h; prior to breakfast, lunch and dinner,
respectively). Saliva samples were collected by adminis-
tering a tampon, chewed by the subject for about a minute;
the samples were immediately frozen at -70 °C.
Prior to testing, participants were instructed regarding
the purpose of the study and were asked to follow the
instructions for the collection of saliva samples: avoid
caffeine and acidic drinks, not brush teeth, eat or drink
anything for 15 min prior to a sample collection.
Anti-stress protocol based on the psychological
functional model
The anti-stress protocol is based on ten sessions and con-
sists in the use of techniques designed to adapt the Func-
tional Model proposed by Luciano Rispoli [12].
Table 1illustrates the guidelines for the deep breathing
technique that included.
Neurol Sci
123
Statistical analysis
Data are presented as the mean ±standard deviation (SD).
The slope of the diurnal change in cortisol level was cal-
culated to estimate how each player fit the normal (i.e.,
descending) profile. A linear regression of the three cortisol
values on the sampling times was calculated, with data
pooled for each player. Steeper slopes represented smaller
bcoefficient values for the slope of the regression, indi-
cating that the decrease in cortisol was more rapid. Flatter
slopes (larger bcoefficient values) indicated slower
decreases or abnormally timed peaks. The average area
under the curve (AUC) was calculated by trapezoidal
estimation using cortisol values. The AUC ‘with respect to
ground’ (AUCg) was also calculated [11] which provides
information regarding the total hormonal output, and thus
the basal activity of the Hypothalamic–pituitary–adrenal
axis of the participants. Comparison were carried out using
the unpaired Student’s ttest or one-way repeated-measures
ANOVA (Friedman test) followed by Dunn’s multiple
comparison test. Correlation analysis was carried out using
one-tailed Pearson’s correlation analysis, and significance
was set at p\0.05. All analyses were performed using
GraphPad Prism version 6.03 for Windows (GraphPad
Software, San Diego, CA, USA) and were carried out
according to the guidelines for reporting statistics in jour-
nals published by the American Physiological Society [14].
Results
POMS test
The scores of the six subscales of the POMS separately
show significant differences in the group of deep breathing
(stress intervention functional IFA), in different parame-
ters, summarized by the total mood disturbance (TMD).
As can be seen in Fig. 1, the value of TMD shows a
significant reduction (p[0.05) in the Experimental Group
between first (I) and last (III) session of deep breathing
(stress Intervention Functional IFA). No significant chan-
ges were observed in the Control Group. No statistically
significant difference was found between men and women
in both Experimental and Control Group.
MSP test
As can be seen in Fig. 2, the values of MSP at the first
session test in both groups show a medium level of stress,
with values ranging between 90 and 100. The values
obtained after the fifth and tenth session were unchanged in
the control group (90 and 100). On the contrary, in the
Experimental Group the values of MPS show a significant
(p[0.05) reduction in the levels of stress between the first
and tenth session. No statistically significant difference was
found between men and women in both Experimental and
Control Group.
Heart rate
The heart rate were measured in the Experimental as well
as Control Group for 5 min at the beginning of the first
session (I), fifth session (II) and tenth session (III).
As can be observed in Fig. 3, the values obtained in the
Control Group do not show any significant change induced
by deep breathing, whereas in the Experimental Group the
level of heart rate exhibits a significant (p[0.05) reduc-
tion between the first and tenth session. No statistically
significant difference was found between men and women
in both Experimental and Control Group.
Table 1 Guidelines for the deep breathing technique For more details of each individual technique, see Rispoli [12] and Blandini et al. [13]
Session In orthostatic position, relaxing of the head and neck, rotating of shoulders, breathing deeply, yawning and imagining to follow the
alternation of the breath
Session Beat hands and feet, chilling down, staggering, imagining to do somersaults between the clouds, sharing
Session Feel parts of the body (standing and walking), contacting back to back the others of the group, remembering tenderness, sharing
Session In orthostatic position, moving the pelvis and modulating the voice, breathing as a butterfly, imagine smooth hills and a calm lake,
sharing
Session Contracting and releasing the body’s muscles, the shoulders to lift and leave, raising and lowering the shoulders, imagining to breathe
deeply, sharing
Session Grimacing, exhaling with eyes half-closed and mouth open, yawning, crawling in the direction of the head, sharing
Session Game with clothespins, breathing and moving the pelvis, imagining of getting lost, self-massaging, imagining to dive, sharing
Session Groping in the dark with eyes closed, producing tremors and convulsions, imagining to follow the alternation of the breath, sharing
Session Rolling on the others of the group, self-massaging the back, self-massaging the neck, imagining to be a leaf in the wind, sharing
Session In orthostatic position, relaxing of the head and neck, rotating the shoulders, breathing deeply, moving together body and arms,
imagining to fly, imagining sand dunes in the wind, sitting in a circle to greet
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123
Salivary cortisol
AscanbeseeninTable2and Fig. 4, the levels of
salivary cortisol at the beginning of the first session
show comparable values in Experimental and Control
Groups. The showed AUCg values are obtained by
averaging the levels measured 30 min after awakening,
at 14:00 and 20:00 h. As can be seen in both Table 2
and Fig. 4, in the Control Group the three measurements
did not exhibit significant differences. However, in the
Experimental Group there is a statistically significant
improvements (p[0.001) between the first (I) and the
last session (III), as well as between the fifth (II) and the
last session (III, p[0.05). No statistically significant
difference was found between men and women in both
Experimental and Control Group.
Discussion
It is generally believed that the deep breathing, practiced
using various techniques, such as qigong and yoga,
improves the sense of well being.
Scientific literature reports remarkable positive effects
induced by the oldest relaxing technique, yoga [15], as
improvement in motor abilities [16], heart rate, blood pressure
and body composition [17,18], cardiorespiratory function
Fig. 1 Mean values of total
mood disturbance (TMD) in the
Experimental as well as Control
Group, measured at the
beginning of the first session (I),
fifth session (II) and tenth
session (III). In the first row,
data of the entire sample are
presented, while in the second
and third row are shown
separately data for men and
women, respectively. Symbols
from ANOVA with Dunns’s
multiple comparison test:
*p\0.05
Neurol Sci
123
[19], forced expiratory volume [18] and maximum vital
capacity [20]. Positive effects were found also on mood states
as anxiety [21] and perceived stress [22,23]. The study carried
out by Hayama and Inoue [5] showed a reduction of ‘tension
anxiety’ and fatigue through the use of deep breathing.
In this study, the use of the technique of deep breathing by a
group of university students showed a significant improve-
ment between the beginning and the end of the training.
The improvements occurred both on the examined
physiological effects (heart rate and salivary cortisol
levels) and on mood and perceived stress, improvements
not observed in the Control Group.
Comparable results were found by Paul et al. [24], who
observed in a longitudinal study, conducted on a sample of
students that the use of deep breathing is capable to reduce
stress, allowing an improvement in academic performance.
This has led the Authors to include in subsequent courses
of this method.
Recently, a systematic review on development of stress
in dental students, reported significant improvements with
deep breathing [25].
Plasma lactate concentrations increase during acute
psychosocial stress in humans [26] and in the last years it
has been observed that the excitability of the Primary
Motor Cortex is improved by high concentrations of blood
lactate, induced not only with a stressful condition as an
exhaustive exercise but also with an intravenous injection
[2731]. It is worth noting that repetitive magnetic stimu-
lation of primary motor cortex is per se capable of
increasing blood lactate [32]. On the other hand, an
Fig. 2 Mean values of
Measurement of Psychological
Stress (MSP) in the
Experimental as well as Control
Group measured at the
beginning of the first session (I),
fifth session (II) and tenth
session (III). In the first row,
data of the entire sample are
presented, while in the second
and third row are shown
separately data for men and
women, respectively. Symbols
from ANOVA with Dunns’s
multiple comparison test:
*p\0.05
Neurol Sci
123
exhaustive exercise induces a reduction of the excitability
of the Supplementary Motor Area [29] and a worsening of
attentional processes [33,34].
In conclusion, although this research have to be con-
sidered a pilot study, the use of deep breathing techniques
has lead to an effective improvement in the management of
stress in daily life, and therefore, could exert positive
influences on the stress conditions that the student must
face during the course of his/her studies.
Fig. 3 Mean values of heart
rate in the Experimental as well
as Control Group measured at
the beginning of the first session
(I), fifth session (II) and tenth
session (III). In the first row,
data of the entire sample are
presented, while in the second
and third row, are shown
separately data for men and
women, respectively. Symbols
from ANOVA with Dunns’s
multiple comparison test:
*p\0.05
Table 2 Mean levels (±standard deviation, SD) of salivary cortisol
(pg/ml) in the Experimental Group and Control Group
I II III
Experimental group
Mean values 9.62 9.53 7.34
SD 1.34 1.53 2.18
Control group
Mean values 9.55 9.53 9.58
SD 1.49 1.80 1.69
Neurol Sci
123
Compliance with ethical standards
Conflict of interest The authors report no conflicts of interest. The
authors alone are responsible for the content and writing of the paper.
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Background: Anxiety associated with surgical stress can lead to high blood pressure (BP), which may end up with undue last minute cancellation of surgery. Relaxation therapy is now being widely used as a complementary therapy for stress and high BP. We conducted a randomized controlled study to compare the effect of relaxation therapy on pre-induction anxiety and BP in hypertensive patients. Materials and Methods: A randomized controlled study was conducted on hypertensive patients undergoing elective surgery. They were allocated into two groups (relaxation therapy and control) using simple randomization with allocation concealment. The relaxation therapy group received intervention by an audio clip an evening prior and 30 min before the scheduled surgery. Their anxiety score on numerical rating scale (0–10) and BP was recorded before and after each intervention. The control group received standard care only. Pre-induction BP and anxiety score were recorded in both groups. The outcome measures were difference in pre-induction anxiety and BP between relaxation and control groups and difference in pre- and post-relaxation anxiety and BP. Results: Out of 70 patients, 30 received relaxation therapy and 34 received standard pre-operative care. There was a significant reduction in BP and anxiety after relaxation therapy in the intervention group (P < 0.0001). The relaxation therapy group showed significantly lower pre-induction systolic BP (138.93 vs. 156.59, P < 0.0001) and anxiety score (2.5 vs. 5.5, P < 0.0001) than the control group. Requirement of anxiolytic drug was less in the relaxation therapy group. Conclusion: Relaxation therapy significantly reduces pre-induction BP and anxiety.
... It is intended to be an indicator of the current experience of stress, as opposed to a marker of symptoms of depression or anxiety [39]. In recent years, the PSM has been used in different study contexts [40][41][42][43][44][45]. Developed by Lemyre and Tessier, this unidimensional scale addresses three distinctive domains of stress: cognitiveaffective, somatic, and behavioral [39,46,47]. ...
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Birthweight is an important predictor of newborn health and has been linked to maternal psychological stress during pregnancy. However, it is unclear whether prenatal stress affects birthweight similarly for both male and female infants. We used a well-established pregnancy cohort to investigate the impact of high maternal psychological stress during pregnancy on birthweight as a function of infant sex. Overall, 5702 mother-newborn pairs were analysed. Of these, 198 mothers reported high levels of stress using the Psychological Stress Measure (nine-items version; PSM-9). Maternal psychological stress was assessed between the 24 th and 28 th week of gestation and analyses were performed jointly and independently as a function of neonatal sex (separate analyses for male and female infants). Newborns exposed to high maternal psychological stress during pregnancy (a score above 26 measured using the PSM-9 questionnaire, corresponding to >97.5 th percentile) were compared to newborns of mothers who reported lower stress. ANCOVAs revealed that high levels of maternal stress during pregnancy were linked to infant birthweight as a function of infant sex. Male infants of mothers who reported high levels of stress had a greater birthweight whereas female infants had a lower birthweight under the same conditions, in comparison to mothers who did not report greater levels of stress. Although the effect size is small, these results underline the possibility that male and female fetuses may use different strategies when adapting to maternal adversity and highlight the need to consider infant sex as a moderator of the association between maternal psychological stress during pregnancy and infant birthweight.
... Breathing exercises are a great way to make the individual more in touch with your mind, body and soul, where intentional deep breathing (yoga-based breathing) can be used as a way to maintain the psychological state, and intentional breathing can also be used to express feelings of anger, especially the uncomfortable feelings that the individual is trying escape from them [18]. [19] indicated that during moments of stress, intentional breathing allows negative energy to be exchanged and released rather than stored within the body. ...
... Functional therapy (FT) is an integrated mind-body approach that takes into account the human organism's deepest psycho-biological mechanisms -the so-called functional processes -such as body memory and peripheral memory, which together constitute the Self (Rispoli, 2008). Some studies showed the efficacy of FT programs in reducing pathological gambling behaviors (Maniaci et al., 2018) and in reducing psychological and physiological correlates of stress (Perciavalle et al., 2017).The main goal of FT for depression, is the increasing of mood and self-esteem via several bodily, cognitive and emotional techniques geared towards helping patients to improve the basic experiences of the self altered by the disorder (for an explanation of Functional theory, see Di Pasquale et al., 2019;Rispoli, 2016). ...
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Objective: Affecting more than 264 million people, depression is a systemic and multifactorial disorder that represents one of the leading causes of illness and disability worldwide. Several studies showed an inflammatory response in depressed patients, including the involvement of both chronic low-grade inflammatory response and activation of cell-mediated immunity. The present study aimed to verify the efficacy of a structured functional therapy program for patients with depressed mood, and to determine whether this program can significantly reduce levels of C-reactive protein. Method: 28 outpatients with depressed mood received 20 individual sessions of Functional therapy. Data about socio-demographic variables, depression, self-esteem, and quality of life were collected; moreover, blood specimens were collected before and after treatment, and CRP measurement was performed by immunoenzymatic method. All measures were administered at baseline, at the end of treatment (i.e., 3 months after baseline), and at follow-up (i.e., 6 months after baseline). Results: A repeated measures ANOVA showed a significant difference after treatment on depression levels, levels of self-esteem, and all dimensions of quality of life, such as physical, psychological, social relationships, and environment. Furthermore, a statistically significant difference on levels of CRP was found. Moreover, at follow-up, improvements were maintained. Conclusions: The study revealed initial evidence of the efficacy of a functional therapy program on treating depression and its psychological and inflammation-related markers.
... Deep breathing has been used in various studies as a relaxation tool (5,(23)(24)(25). Inhaling and exhaling affects the oscillations of the heart rate through a process known as respiratory sinus arrhythmia (RSA). ...
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Für ein seelisches und körperliches Wohlbefinden spielt auch ein ausbalancierter Hormonhaushalt eine wesentliche Rolle. Gerät dieser aus dem Gleichgewicht – zum Beispiel durch Stress, durch zu wenig oder auch durch zu intensive Bewegung oder einseitige Ernährung –, hat das weitreichende Konsequenzen. In diesem Kapitel werden die dafür wesentlichen Hormone Oxytocin, Cortisol und Serotonin vorgestellt und in ihrer Wirkweise erklärt.
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The influence of exercise mode and practice qualities on the stress reduction benefits of exercise was examined. College students in swimming, body conditioning, hatha yoga, fencing, exercise, and lecture-control classes completed the Profile of Mood States and the State Anxiety Inventory before and after class on three occasions. Swimmers had unusually positive initial moods and reported less tension and confusion after swimming only on the first day of testing. Participants in yoga, an anaerobic activity that satisfied three of the four mode requirements, were significantly less anxious, tense, depressed, angry, fatigued, and confused after class than before on all three occasions. Supporting the importance of the four mode characteristics, participants in the exercise control activity of fencing reported improvements only in vigor. A possible influence of practice conditions was observed when members of the body conditioning class reported significant increases in fatigue, but no other mood changes. Results of this study supported the possibility that exercise mode and practice requirements in the proposed taxonomy moderate the stress reduction benefits.
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The specific guidelines listed above can be summarized by these general ones: Analyze your data using the appropriate statistical procedures and identify these procedures in your manuscript: Guidelines 2-4. Report variability using a standard deviation, not a standard error: Guideline 5. Report a precise P value and a confidence interval when you present the result of an analysis: Guidelines 6-10. If in doubt, consult a statistician when you design your study, analyze your data, and communicate your findings: Guideline 1. The mere adherence to guidelines for reporting statistics can never substitute for an understanding of concepts and procedures in statistics. Nevertheless, we hope these guidelines, when used with other resources (4, 8, 9, 11, 12, 14), will help improve the caliber of statistical information reported in articles published by the American Physiological Society.
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