'Sighing' Tops Mindfulness for Reduced Stress, Improved Mood

Megan Brooks

February 02, 2023

Cyclic sighing is more effective than mindfulness meditation for improving mood and reducing stress, new research suggests.  

In a randomized controlled study, daily breathwork — especially cyclic breathing, which emphasizes shorter inhalations and prolonged exhalations — was associated with greater improvement in mood and a slower respiratory rate than mindfulness meditation.

"We were pleased that just 5 minutes a day of the breathing exercises positively affected mood and resulted in slower respiratory rate, indicating reduced arousal," co-investigator David Spiegel, MD, who directs the Center for Stress and Health at Stanford University, Stanford, California, told Medscape Medical News.

The findings were published online January 10 in Cell Reports Medicine.

Intentional Breath Control

Controlled breathwork has emerged as a potential tool to manage stress and boost well-being.

In the new study, researchers compared three different daily 5-minute breathwork exercises to an equal amount of mindfulness meditation over 1 month in 108 healthy adults recruited mostly from an undergraduate psychology class at Stanford:

  • 33 participants practiced cyclic hyperventilation, which emphasizes robust inhalation, short retention and rapid exhalation

  • 30 did exhale-focused cyclic sighing

  • 21 performed box breathing, which emphasizes equal duration of inhalation, breath retention, and exhalation

  • 24 practiced mindfulness meditation (the control group)

The primary endpoints were improvement in mood and anxiety, as well as reduced physiologic arousal (respiratory rate, heart rate, and heart rate variability). Physiologic data was collected using a wearable WHOOP strap (WHOOP Inc).

All four groups showed significant daily improvement in mood, as well as reduction in anxiety and negative mood, but there were significant differences between mindfulness meditation and breathwork.

Using a mixed-effects model, the researchers showed that breathwork, especially the exhale-focused cyclic sighing, produced greater improvement in mood (P < .05) and reduction in respiratory rate (P < .05) compared with mindfulness meditation.

Specific Patterns vs Passive Attention

The finding supports the team's hypothesis that intentional control over breath with specific breathing patterns produces more benefit to mood than passive attention to one's breath, as in mindfulness meditation practice.

"It turned out that the cyclic sighing was indeed most soothing," Spiegel noted.

"We expected that because of respiratory sinus arrhythmia. Exhaling is accomplished by increasing pressure in the chest, which increases venous return to the heart, triggering parasympathetic slowing of heart rate via the sinoatrial node," he said.

Spiegel added that, conversely, inspiration reduces venous return, triggering sympathetic activity and increased heart rate.

"The magnitude of this heart rate variability is associated with better health, including recovery from myocardial infarction and even cancer survival. So self-soothing is a good thing, and we expected an advantage for cyclic sighing," he said.

"If you're looking to improve sleep and reduce daytime stress, recover from intense work, life and/or training, then interventions that facilitate autonomic control (and indeed you can control it), brief (5 minutes) structured breathwork is among the more powerful (and zero cost) tools," tweeted senior investigator Andrew Huberman, PhD, professor of neurobiology at Stanford.


Immediate Application?

Commenting for Medscape Medical News, Sara Lazar, PhD, Massachusetts General Hospital and Harvard Medical School in Boston, said the findings are "interesting" but cautioned that this is "just one study with a pretty small sample size," and it only enrolled healthy college students.

Lazar, who also runs the Lazar Lab for Meditation Research at Mass General, noted that she would want to see a future study "done with working-age adults and with clinical populations."

"It should also be noted that mindfulness had a bigger effect on negative affect, which could have implications for conditions such as depression or trauma," said Lazar, who was not involved with the current research.

Also weighing in, Steven R. Thorp, PhD, professor at California School of Professional Psychology, Alliant International University, San Diego, told Medscape Medical News the study is "really interesting and well-done."

"Although breathing exercises and breathing retraining are commonly found in psychosocial interventions, especially for anxiety disorders, there have been few empirical studies comparing different breathing protocols," Thorp said.

In this study, the passive observation of breaths (mindfulness) and specific breathwork interventions "all worked to decrease state anxiety; but the breathwork, particularly the cyclic sighing protocol, produced a greater overall reduction in respiratory rate and increase in positive mood," he noted.

"These techniques can be recommended by all clinicians because all clients have access to their breath at all times — and only 5 minutes of daily practice can yield the benefits. Moreover, as the authors note, the immediate benefits may encourage clients to engage with the breathwork and potentially other aspects of treatment," Thorp said.

The study was funded by Victor and Winnie Koo and Tianren Culture and a Stanford School of Medicine Discovery Innovation Award. WHOOP Inc donated the wrist straps used in the study, but was not involved in the study's design or analysis. Huberman is an advisor to WHOOP. Lazar and Thorp have reported no relevant financial relationships.

Cell Rep Med. Published online January 10, 2023. Full text

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