The purpose of this study was to evaluate the effects of a computer program on the training and maintenance of diaphragmatic breathing. The biofeedback portion was visual computer training and the results were displayed concurrently with participants' breathing responses to monitor display. The verbal feedback portion was praise that was given and recorded when participants responded with predominantly diaphragmatic breathing at the scheduled moment and response instruction that was given when participants responded with predominantly thoracic breathing. The results of this study indicate the computer program's effectiveness needs to be increased by supplementation with verbal feedback.

Persistent pain conditions are a major health problem throughout the world and are one of the primary reasons that people seek medical treatment (Gureje, Von Korff, Simon, & Gater, 1998; Verhaak, Kerssens, Dekker, Sorbi, & Bensing, 1998). These conditions are characterized by complex interactions between cognitive, emotional, and physiological disturbances and are often associated with comorbid psychological disorders (Gatchel, 2004). Though previous studies have examined the effect of interventions targeting persistent pain, such as physical self-regulation interventions, few studies have examined the complex interaction between such interventions and other variables such as psychological and physiological functioning and presence of social support. The current study was designed to evaluate the effect of a physical self-regulation intervention (i.e. diaphragmatic breathing entrainment) on response to a brief physical stressor (i.e., mild thermal stimulation) as well as to evaluate whether presence or absence of a supportive partner influenced this relationship. Participant response was measured via self-report of pain intensity and unpleasantness and via physiological measures of respiration rate, blood pressure, heart rate, and heart rate variability. The study consisted of 154 female participants who participated in pairs (i.e., 77 pairs). Each participant was randomly assigned to training in diaphragmatic breathing or a control condition as well as being randomly assigned to complete the study with or without their supportive partner present. Analyses revealed that breathing entrainment resulted in significantly slower breathing rate during the thermal stressor task (p < .01). Presence of a supportive partner interacted with breathing entrainment to influence heart rate during the thermal stressor task (p < .05) such that participants who completed the study with a support person present had a lower heart rate when trained in diaphragmatic breathing than when trained in a control protocol and participants who did not have a support person present showed the opposite effect. Presence of a supportive partner also interacted with breathing entrainment to influence ratings of task unpleasantness (p < .05) such that participants who were trained in diaphragmatic breathing rated the task similarly regardless of presence or absence of a supportive partner, whereas participants who were trained in a control protocol rated the task as more unpleasant when accompanied by a supportive partner. In conclusion, the present study demonstrates the impact of training in diaphragmatic breathing and presence of social support on response to thermal stimuli as measured by both self-report (i.e., ratings of task unpleasantness) and physiological (i.e., respiration rate and heart rate) measures. This study highlights the usefulness of implementing a self-regulatory training strategy for treatment of pain and in considering the efficacy of incorporating a supportive partner into such training.

A central component of many psychological interventions is breathing training. Breathing training protocols based on a mindfulness or a cognitive behavioral therapy (CBT) have demonstrated value in the management of psychological and medical ailments. Yet, despite the wealth of literature examining each approach, little direct comparison exists. An additional concern is the proliferation of smart phone health (mHealth) applications (apps) providing breathing training with little empirical evidence to support their clinical use. A possible explanation for the interest in breathing and mHealth apps is the growing body of literature indicating breathing training provides wide ranging health benefits through improved stasis of the autonomic nervous system (ANS). As ANS dysregulation underlies many chronic health conditions such as persistent temporomandibular disorders (TMDs), there is a need for empirical research to identify the most effective modality of breathing training and validate the clinical efficacy of breathing based mHealth apps. Study One compared the effectiveness of a mindfulness breathing meditation (MB) and a CBT based protocol teaching diaphragmatic breathing (DB) to improve biomarkers of ANS stasis. An attention control approach based on the Nolen-Hoeksema task (C) was included as a comparison group. Ninety participants were randomly assigned to either the MB, DB, or C condition. Within each condition, 30 participants were provided skills training with practice time and completed a behavioral self-regulation task. Participants in the DB condition approach had significantly lower breathing rates than those in the MB and C conditions (p < .001). DB condition participants experienced improvements on high-frequency heart rate variability (p < .05) and the standard deviation in NN intervals (p < .001), which served as indicators for ANS stasis. No differences were found between conditions on the behavioral self-regulation task (p’s > .05). Given these results, the DB training protocol was converted into a mHealth app to facilitate a clinical trial with patients suffering persistent TMDs. Study Two examined the additive benefits of including the mHealth app with standard dental care (SDC+) versus standard dental care alone (SDC). Nineteen patients seeking care for persistent TMDs were recruited. All participants were asked to track daily ratings of pain (VAS), relaxation (RR), and complete weekly assessments on several comorbid psycho-social factors. Within the SDC+ condition participants were asked to track the proximate effects of each breathing practice on VAS and RR ratings. Given a high drop-out rate (nine participants) and low overall sample size (N = 10), results are exploratory at best. Within the SDC+ condition, results indicated reliable improvements in average VAS and RR ratings from before and after SDC+ participants used the mHealth app (p’s < .05). Within a one session training paradigm, results supported the use of a DB based intervention above the use of a MB or C intervention. Future research should consider the effects of having multiple training sessions. Study Two results were complicated by a limited sample size and failed to provide a clear picture of whether the conjunctive treatment in the SDC+ condition provided additional symptom relief above traditional dental care alone. Although exploratory results indicated the mHealth app provided temporary improvements in pain and feelings of relaxation, a well powered trial is needed to clarify whether the finding represents an enduring treatment effect.

Evidence suggests that slow paced diaphragmatic breathing (DB) can significantly affect prefrontal cortex functions through increasing an individual’s physiological self-regulatory capacity. The current research demonstrates the effects of paced DB on inhibitory control, which is considered to be a reliable measure of behavioral self-regulation. Eighty healthy participants were randomly assigned to one of two conditions (20 males and females each). Participants were instructed on either DB at a pace of six-breaths per minute (BPM) or instructions on environmental awareness and asked to breathe at 12 BPM. Following training, all participants completed a computer-based task designed to examine inhibitory processes. Physiological recordings of heart rate (HR), BPM, and HRV were collected at baseline, during the breathing training, during the cued go/no-go task, and after the cued go/no-go task. The findings demonstrated that the DB condition had significantly lower BPM, HR, and higher HRV (p’s<0.05) during active training than the environmental awareness condition. Furthermore, the DB condition performed significantly better on the measure of inhibition than the environmental awareness condition (p<0.05). The use of DB as a reliable method to increase physiological self-regulatory capacity and improve behavioral self-regulation, measured as inhibitory control, should continue to be explored.

Title: Effect of mobility exercises in offline and online environment on subjective perception of back pain Objectives: The main goal of this work was to determine whether the onset of daily mobility contributes to the reduction of individual's back pain perception. Within the work the results between the offline and online group was compared. Methods: The diploma thesis has the character of qualitative research, where case study of 20 probands was applied. Online input and output questionnaires were compiled to obtain data, which respondents filled in at the beginning and end of the intervention. Results: The research included 11 women and 9 men aged 21 - 44 years. Individuals have mostly sedentary jobs and some of them play recreational sports in their free time. At the end of the intervention, all individuals showed an improvement on the scale of the pain intensity, when the perceived back pain was alleviated or disappeared. The offline group performed better than the online group. Conclusion: The study confirmed that the inclusion of daily mobility contributes to the reduction of subjectively perceived back pain. It confirmed that exercising in offline lessons is more effective than in an online environment. Keywords: mobility, back pain, diaphragmatic breathing, torso stabilization, DNS

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