NSM Curated Studies + Literature

Significant autonomic irregularities preceded the onset of attacks that were reported as abrupt and unexpected. The findings invite reconsideration of the current diagnostic distinction between uncued and cued panic attacks.

The mindful awareness in body-oriented therapy (MABT) approach offers a framework for understanding how interoceptive awareness facilitates emotion regulation. MABT develops the distinct interoceptive awareness capacities of identifying, accessing, and appraising internal bodily signals and provides an individualized protocol for scaffolding interoceptive awareness.

Interoception may help in appraising physiological signals in social situations and flexibility in engaging interoception in social situations may be important for regulation. This paper proposes that interventions aimed at improving interoceptive abilities may be key for alleviating loneliness and improving social connection.

During meditation, 11C-raclopride binding in ventral striatum decreased by 7.9%. This corresponds to a 65% increase in endogenous dopamine release.

A phylogenetically novel pathway to the thalamus and cortex represents all aspects of the physiological condition of the physical body, forming a representation of the material me.

In right anterior insular/opercular cortex, neural activity predicted subjects' accuracy in the heartbeat-detection task, and local grey-matter volume in the same region correlated with both interoceptive accuracy and subjective ratings of visceral awareness.

Dysfunction of interoception is increasingly recognised as an important component of anxiety disorders, mood disorders, eating disorders, addictive disorders, and somatic symptom disorders.

Three dimensions of interoception were distinct and dissociable: accuracy (objective heartbeat tracking), sensibility (self-reported perception), and awareness (metacognitive correspondence).

The MAIA is a validated 32-item multidimensional self-report measure of interoceptive body awareness across eight subscales (Noticing, Not-Distracting, Not-Worrying, Attention Regulation, Emotional Awareness, Self-Regulation, Body Listening, Trusting).

Interoceptive training improved five of eight aspects of interoceptive awareness on the MAIA compared to retest controls, with participants with low baseline scores showing the biggest changes.

Heartbeat-perception accuracy increased steadily over 9 months of contemplative training (d = 0.17 at 6 months, d = 0.27 at 9 months), concomitant with decreases in alexithymia.

After 8-week MBSR, experiential focus produced increased recruitment of a lateral PFC + right insula network and decoupling of insula from medial PFC.

Women with substance use disorder assigned to MABT plus treatment-as-usual showed improvements in substance use, respiratory sinus arrhythmia, and interoceptive awareness vs. treatment-as-usual.

Mind-body therapies in chronic-pain populations produced significant improvements in total interoceptive awareness (Becker's d = 1.17) plus improvements across seven of eight MAIA subdomains.

The heartbeat counting task largely involves non-interoceptive processes. Performance is heavily predicted by prior knowledge of resting heart rate, time-estimation ability, and response bias.

This experimental study investigated the effects of three different 5-min daily breathwork exercises on mood, anxiety, and physiological arousal. It found that cyclic sighing produced greater improvement in mood and reduction in respiratory rate compared to mindfulness meditation.

Hypoarousal and failure to sigh have been associated with sudden infant death syndrome. Increased breathing irregularity may provoke excessive sighing and hyperarousal, a behavioral sequence that may play a role in panic disorders. Essential for generating sighs and breathing is the pre-Bötzinger complex.

The polyvagal perspective emphasizes how an understanding of neurophysiological mechanisms and phylogenetic shifts in neural regulation, leads to different questions, paradigms, explanations, and conclusions regarding autonomic function in biobehavioral processes than peripheral models.

Breathing exercises have been shown to significantly reduce oxidative stress biomarkers in humans.

This examination of the efficacy of breathwork interventions for adults with clinically diagnosed anxiety disorders finds that breathwork interventions yielded significant improvements in anxiety symptoms and supports the clinical utility of breathwork interventions.

Flexibility of the autonomic nervous system is particularly important for adaptive stress responses and may contribute to individual differences in resilience. By analysing heart rate variability (HRV), this study evaluates the link between autonomic flexibility (regulation) and sympathovagal balance (resilience).

This paper proposes a model of Apnea-induced Anxiety which suggests that recurring episodes of apnea are being unconsciously elicited by amygdala activation, leading to fear and anxiety, which suggests the chemical basis for anxiety and can support anxiety-reducing interventions.

Based on recent evidence that slow-paced breathing (SPB) and heart rate variability-biofeedback (HRV-BF) can strengthen the nervus vagus’ anti-inflammatory pathway, these researchers studied the effects of decreasing certain pro-inflammatory cytokines in the reduction of cardiovascular diseases and metabolic syndrome.

We hypothesize that reversing homeostatic alterations with meditation and breathing techniques rather than targeting neurotransmitters with medication may be a superior method to address the whole body changes that occur in stress, anxiety, and depression.

This meta-analysis studied the effect of breathwork on stress and mental health and found that breathwork was associated with lower levels of stress, anxiety, and depressive symptoms compared to control conditions.

Heart rate variability biofeedback (HRVB) significantly improves heart rate variability (HRV). Breathing at resonance frequency (RF, approximately 6 breaths/min) constitutes a key part of HRVB training and is hypothesized to be a pathway through which biofeedback improves HRV.

A number of studies have revealed that diaphragmatic breathing may trigger body relaxation responses and benefit both physical and mental health. This study provided evidence demonstrating the effect of diaphragmatic breathing, a mind-body practice, on mental function, from a health psychology approach, which has important implications for health promotion in healthy individuals.

The ‘nasal cycle’ is where breathing alternates between the right and left nostril. Adopting the nasal cycle has been shown to integrate EEG value in one hemisphere of the brain with predominant airflow in the contralateral nostril, which defines a new interrelationship between cerebral dominance and peripheral autonomic nervous function.

Although a lot of empirical research suggests that slow breathing can be used as a prevention technique to support physical and mental health, little research has been done on the effects on heart-rate variability and its link with health outcomes. This paper conducts a systematic review and meta-analysis of the current literature.

Slow breathing (~6 breaths/min) increases HRV and baroreflex sensitivity via respiratory modulation of vagal afferents and 0.1 Hz cardiorespiratory coupling.

Humming produced a 15-fold increase in nasal nitric oxide compared to quiet exhalation, via oscillatory gas exchange between paranasal sinuses and nasal cavity.

Wim Hof-trained subjects voluntarily raised epinephrine, increased anti-inflammatory IL-10, and suppressed the TNF-α, IL-6, and IL-8 response to endotoxin.

Brief cold face immersion (trigeminocardiac/diving reflex) reduced acute cortisol and subjective stress responses and increased cardiac vagal activity.

One hour in 14°C water raised plasma norepinephrine 530% and dopamine 250% above baseline. Effect size matters: this is not a subtle intervention.

The ~10-second baroreflex-loop delay produces 0.1 Hz resonance; breathing at this rate maximises HR-oscillation amplitude.

The myelinated ventral vagus co-regulates heart rate and facial/laryngeal muscles as an integrated social engagement system; neuroception evaluates safety cues below consciousness.

The five foundational premises of polyvagal theory (phylogenetic ordering; RSA as vagal index; dorsal-vagal shutdown; ventral-vagal social engagement; face-heart link) are challenged as inconsistent with established neurophysiology.

Somatic Experiencing is designed to direct the attention of the person to internal sensations that facilitate biological completion of thwarted responses, thus leading to resolution of the trauma response and the creation of new interoceptive experiences of agency and mastery.

This paper discusses the complex neural control system of breathing, and its connectivity to emotion and cognition and suggests that breathing has a broad influence on the brain and body.

Studying the effects of allostatic load on cellular energy expenditure has found that chronic glucocorticoid exposure increases energy expenditure and is linked to mtDNA instability, accelerated cellular aging, and reduced lifespan, and thus suggests that increased stress is linked to accelerated biological aging.

Interoception is the ability to perceive one's inner bodily feelings and is thought to be associated with the capacity of recognising and experiencing emotions. This study looks at interoception from the individuals’ perspective.

Psychological safety is increasingly recognized as central to mental health, wellbeing and posttraumatic growth. The NPSS is a novel measure of psychological safety which can be used across a range of health and social care settings. The NPSS will help shape new approaches to evaluating trauma treatments, relational issues and mental health concerns.

Human representation-based attachments are characterised by biobehavioural synchrony and integrate subcortical with cortical networks implicated in reward/motivation, embodied simulation, and mentalization.

Mother and infant coordinate heart rhythms within lags of less than 1 second. Concordance increased significantly during episodes of affect and vocal synchrony compared to non-synchronous moments.

Most-cited short introduction to the Feldman programme, laying the foundations for biobehavioural synchrony as a developmental framework connecting caregiver attunement, infant regulation, and long-term social capacities.

A pervasive attenuation of activation in the neural systems supporting emotional and behavioural threat responses when the women held their husband's hand.

Increased positive emotions produced increases in vagal tone, an effect mediated by increased perceptions of social connections.” (Note: 2016 corrigendum revised some effect sizes; the mediation pattern held.)

The human brain treats social relationships as metabolic resources; proximity to trusted others decreases perceived environmental demands and threat responses.

Physiological activity between two or more people becomes associated or interdependent across varied relationships and contexts, but effect sizes and directions vary with task, relationship, and measurement choice.

Sympathetic-synchrony was positively related to relationship outcomes; parasympathetic-synchrony was negatively related. Direction and channel matter.

Significant synchrony in respiration, HR, and HRV linked to alliance ratings. Co-regulation in adult clinical dyads.

Movement and physiological synchrony between therapist and patient predicts alliance quality and outcome.

Attachment-related security is associated with differential vagal regulation during emotionally demanding interpersonal exchanges, providing a physiological substrate for attachment-driven co-regulation.

Heart rhythm coherence (a smooth, sine-wave-like HRV pattern at ~0.1 Hz) is associated with improved cognitive performance, emotional stability, and self-regulation capacity. Within-body cardiac coherence is the defensible claim; between-body heart-field coupling remains speculative.

HRV biofeedback produced a large pre-post within-group effect (Hedges' g = 0.81) and a large between-group effect versus controls (g = 0.83) on self-reported stress and anxiety.

HRV biofeedback produced significant small-to-moderate effects across emotional and physical health domains, with largest effects for anxiety, depression, anger, and athletic/artistic performance, and smallest for PTSD, sleep, and quality of life.

Ten sessions of HRV biofeedback at individually-assessed resonance frequency increased baroreflex gain and peak expiratory flow with effects persisting after training. Foundational clinical RCT.

Resting vagally-mediated HRV indexes the integrity of a prefrontal-subcortical inhibitory circuit, and higher HRV predicts better executive-function performance on tasks requiring cognitive and emotional regulation.

HRV co-varies with regional cerebral blood flow in the ventromedial prefrontal cortex, amygdala, and anterior cingulate — the same circuits implicated in autonomic and affective regulation.

A single 15-minute session of resonance-frequency breathing produced more positive mood, higher LF/HF ratio, and a reduced blood-pressure response to an acute cognitive stressor than both an RF+1 breathing control and a seated control.

HRV biofeedback reduced depressive symptoms (g = 0.38, 95% CI 0.16-0.60). Clinical-population anchor, more conservative than Goessl 2017.

Mindfulness meditation produced moderate improvement in anxiety (ES 0.38 at 8 weeks) and depression (0.30 at 8 weeks), low evidence elsewhere. Calibration study for mindfulness effect sizes.

Major depressive disorder is associated with significantly reduced HRV, medium-to-large effect sizes, partially independent of antidepressant treatment.

Mindfulness-based interventions did not significantly increase vagally-mediated resting-state HRV relative to control conditions (Hedges' g = 0.38, 95% CI -0.014 to 0.77, CI crosses zero).

An 8-week mindfulness-based contemplative intervention produced measurable but modest shifts in vagally-mediated HRV in non-clinical adults. One of the better-powered RCTs in the mindfulness-HRV literature.

Chronic activation of stress-response systems produces cumulative "allostatic load" measurable across cardiovascular, metabolic, neuroendocrine, and immune systems.

To date, neuroscientists usually investigate one brain at a time. Now, collective neuroscience, as some practitioners call it, is a rapidly growing field of research. An early, consistent finding is that when people converse or share an experience, their brain waves synchronize.