What are the most effective breathing protocols to regulate arousal? Box breathing? Cyclic Sighing? Cyclic Hyperventilation with Retention? And can we also regulate ourselves (down) by using the visual system (through the so-called panorama vision) as Andrew Huberman tells us in various podcast? Via Zoom, I spoke about this with Melis Yilmaz Balban, who along with Huberman and Spiegel (the man behind the study of hypnosis) wrote this article about the science of breathing!
What was/is the topic of your research and what are the main and what are the key insights?
I did my PhD at Harvard University in Dr. Markus Meister’s (currently at Caltech) lab. My PhD dissertation was on characterizing threat responses and the neural circuits guiding these responses in rodents.
I moved to Dr. Huberman’s lab for my post-doctoral research. In the Huberman lab I studied human threat responses and interventions to manage stress. To study human threat responses I created a Virtual Reality paradigm.
What is the goal and ambition of your company Neurosmart en what do you need from LEO trainers?
Our goal at Neurosmart is to have every LE officer rain for self-awareness and regulation during the academy and then regularly in-service, similiar to firearms training. I see self awareness as essential as firearms for Law Enforcement. It should be formally trained and evaluated.
In ‘brief structured respiration practices enhance mood and reduce physiological arousal’ (1) have examined various breathing protocols for arousal and mood, among other things. Which protocols did you examine and what was the conclusion?
We compared 3 different breathing protocols to a meditation practice that resembles focus meditation. Participants were instructed to practice their assigned protocol for 5 minutes a day for 4 weeks. The primary goal of the study was to compare practices that intentionally shape the breath to a practice that passively observes it. The three breathing techniques were:
- Cyclic Sighing (exhale focused): Double inhale through the nose to fully inflate the lungs, followed by a long exhale through the mouth. Repeat for 5 minutes.
- Box Breathing (equal inhale-exhale): Inhale-hold-exhale-hold. All equal ratios at a pace comfortable for you. Repeat for 5 minutes.
- Cyclic Hyperventilation with Retention (inhale focused): Deep inhale through the nose followed by a passive “fall out from the mouth” exhale. Repeat this for 30 breaths and after those 30 breaths, exhale all air via the mouth and calmly wait with lungs empty for 15 seconds. Repeat for 3 rounds.
The conclusions:
- All practices resulted in acute reduction in anxiety and improvement of mood as measured immediately before and after the 5 minutes.
- Cyclic Sighing resulted in greater increase in mood than the Meditation Practice, as measured immediately before and after the 5 minutes.
- Cyclic Sighing resulted in more reduction in respiratory rate than the Meditation practice over the course of the study indicative of reduction in sympathetic tone. ( measured as change over 4 weeks).
Note Erik: see also this great interview about her research and the use in police training with Chris Butler:
We use extended exhalation a lot (see also the article about ‘The Effectiveness of Combat Tactical Breathing as Compared with Prolonged Exhalation’, see illustration below) . Would the inclusion of this technique have changed the outcome since it is short and parasympathetic)?
We think it is the prolonged exhalation that mediates the effects of Cyclic Sighing by activating the parasympathetic nervous system. However we do not know that for sure. If that is the case, Prolonged Exhalation would work equally well.
Tactical breathing is very popular with first responders. What does this technique do physiologically (e.g., the holds) and is it the most effective in acute situations? What can explain the effect of this technique?
We have found extended exhale focused Sighing practice to be more effective than Box breathing. I don’t think there are enough good studies out there that study why certain breathing techniques work and work better than others. There are several factors to consider with breathing:
(1) It gives conscious control over the nervous system. The increased perception of control might reduce anxiety.
(2) Paying attention to breath generally decreases breathing rate, also calming the body and the mind.
(3) The inhale – exhale ratios. Inhales are generally activating and exhales are calming.
What role does percieved control play in all these stress regulation techniques?
Perceived control is an important part of wellbeing. Reduced perceived control has been associated with both anxiety and depression. Breathing gives one a tangible tool to control their own physiological state thus increasing perceived control. Some of its beneficial effects can be mediated by this, however this has not been directly tested.
In our conversation, we talked about how the effectiveness of all these techniques must come about primarily through daily practice. That it is a habit that you can fall back on. Can you talk a little bit more about this?
In our study we found that the daily benefits increase with more days of practice, an effect that became more apparent after 3 weeks of practice. Self regulation is definetely a muscle we need to practice regularly to keep building. In our study we show that as little as 5 minutes a day is beneficial. In addition the more we benefit from it the more we are likely to do it regularly. So I would encourage everyone to find their 5 minutes practice, it could be meditation or breathwork, that they can adhere to on a daily basis for long term benefits.
Mindfulness is not a direct tool we can use in a action but you / we find it very valuable. What role can mindfulness play in our overall mental health and indirectly as a basis for performing under pressure?
Too many to list. But here are some of my favorites that link mindfulness meditation directly to changes in neural activity.
- Mindfulness meditation reduces default mode network activity, leading to higher cognitive control and less mind wandering. This leads to more task focus and execution.
- Mindfulness meditation improves tolerance to anxiety by reducing the activity of the brain area that interprets pain and anxiety signals (insula).
- Mindfulness meditation improves cognitive control over impulsive responses by improving connectivity of the prefrontal cortex to the limbic system.
What is interoception and what role can it play in self-regulation? How is interoception in people with anxiety or depression?
Interoception is the two way communication between the body and the nervous system that allows the nervous system to sense, interpret and regulate signals of the body. It is an essential component of self-regulation becaase without proper awareness and interpretation of the body’s signals we can not know if we are stressed and need to self-regulate.
Stress, anxiety, depression and many other mental health disorders (e.g. eating disorders, substance abuse) are all associated with impaired interoception. When the interoceptive process is disrupted, the mis-interpreted physical sensations contribute to the pathology of the mental illness. (e.g. paying excessive attention to the body, catastrophic thinking about minor illnesses etc).
What did you research in “Human Responses to Visually Evoked Threat” and what insights can we bring to first responder training?
We found that people with anxiety differ from people without anxiety in their physiological and behavioral responses to simple threats (such as virtual heights) even when they don’t report being more scared or anxious. This shows that we cannot rely on self-report when people are experiencing trauma and anxiety but need to measure their behavior, physiology and performance to accurately detect changes in performance. The best place to do that for law enforcement is during training.
Human Responses to Visually Evoked Threat (sciencedirectassets.com)
What are the basic mechanisms of stress on the visual system (for example on pupils etc)?
Sympathetic nervous system activation causes pupils to dilate in order to let more light in and shorten the depth of vision so we can focus on near threats.
What is the effect of stress on our viewing behavior (gaze behavior/visual system) when we experience stress?
We found that anxiety increases lateral head movements and gaze, similar to scanning the environment for potential threats and not focusing on a particular task or point. We interpret this as a sign of hypervigilance.
Can we consciously use gaze behavior to calm ourselves?
Eye movement desensitization and reprocessing (EMDR) therapy is a treatment technique that is designed to reprogram traumatic memories. This is not an area I am in dept knowledge on and I am not aware of many scientific studies that look at conscious eye-movements for reducing anxiety (other than the literature on EMDR).
Note Erik Hein: See for example Huberman talking about using eyes to calm down in this clip:
What is the scientific method and how can trainers learn to read and assess scientific research?
I would make sure to check that the research article is peer reviewed and if it isn’t recent I would look for additional articles that support the claims (or similar claims) and not rely on a single article.
I would avoid taking popular journal articles, or articles from famous scientists (including ours!) at face value and encourage everyone to be always critical.
Other than that to really evaluate a research article one needs in-dept expertise on the topic or on statistical methods. Trainers can get educated on these topics and/or work with academics.
Is there a topic or question I did not ask but is very important for you?
Nope! Thank you for the insightful questions.
Sources
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:
Inspiration
See also this great blog by Brian Willis :
Are you teaching effective breathing, or just talking about it? | Winning Mind Training