Airways to Alteration

Updates:

This pre-reg has now received Ethical Approval and protocol registration is underway, along with study advertisement.
Authors added to research team include: Alessandro Colasanti, Amy Kartar, and Edward Caddye.
Secondary outcome measures added to the study include: Imperial Psychedelic Predictor Scale (IPPS), Sleep-Related Impairment, Shortened Fatigue Questionnaire, and Cambridge Depersonalisation Scale.

Request: Participant payments have increased, so breathwork intervention related costs are now: $1,100. Any donations (or tips) would be greatly appreciated!

Brief: Essentially, we will be comparing a single guided session of high ventilation breathwork (HVB; intervention) to a single guided session of body scan meditation (control). Then, using the Altered States Database, an open-science project based on systematic literature reviews (Prugger et al., 2022), we can compare to prior data on altered state-induction methods like meditation and psychedelics. The primary aim is the impact of HVB and meditation on altered states of consciousness (ASCs). Secondary aims relate to mental health and wellbeing. For the first time we will also examine the relationship between predictiveness of the psychedelic experiences emerging from HVB and meditation.

Principal research questions/objectives: 1. Investigate potential differences in ASCs induced by a single session of HVB - in particular Conscious Connected Breathing (CCB) - versus a body scan meditation. 2. Examine whether HVB (CCB) induces ASCs comparable to psychedelics (via the Altered States Database, an open-science project based on systematic literature reviews). 3. Investigate potential differences on mental health and wellbeing after HVB or a body scan meditation. 4. Examine correlation between ASCs and changes on mental health and wellbeing, in addition to the relationship between preparedness/predictiveness of participants to experience psychedelic effects and ASCs.

Airways to Alteration?

Investigating the impact of breathwork on conscious state

Interested in helping fund early research on high ventilation breathwork (HVB)? HVB represents an emerging nonpharmacological alternative for potentially inducing altered states of consciousness (ASCs) akin to psychedelics. Most breathwork research at present has been on slow-paced techniques, however the field of HVB is currently in its infancy with initial research reporting ASCs induced by HVB to be comparable to medium-high doses of psylocibin. Nonetheless HVB has not yet been exposed to rigorous testing through a robust randomised-controlled trial, and this is what our one-year project will do. Research on breathwork is poised for an extraordinary surge in both public and scientific inquiry, much like meditation over the past few decades, and now psychedelics. Given HVB's close ties with these, we expect substantial growth in the field and, as such, encourage robust examination of HVB from the outset.

Author/Affiliation

Guy W. Fincham

Brighton & Sussex Medical School, Department of Neuroscience, University of Sussex, UK

Abstract

“Breath” is derived from the Latin “spiritus”—translating to spirit, soul or life force. We can live for weeks without food, days without water, but only minutes without breath. Through this research project, we aim to meticulously examine the phenomenological effects of high ventilation breathwork (HVB), a body of contemplative practices designed to induce altered states of consciousness (ASCs). While psychedelics are not broadly accessible due to cost/time restraints and legal/medical barriers, HVB represents one of the most accessible, emerging nonpharmacological alternatives for inducing ASCs akin to such drug compounds. In fact, initial research suggests that ASCs induced by HVB may be comparable to medium-high doses of psilocybin. However, the field of breathwork is in its infancy, akin to meditation several decades ago, and HVB’s impact on ASCs has not been exposed to rigorous testing through any kind of randomised-controlled trial (RCT). Our plan for a one-year project funded by ResearchHub is to conduct a well-designed pilot RCT on the effects of guided, intensive HVB on established psychological outcome measures of ASCs, mystical experiences, emotional breakthrough, insight, mental health and wellbeing. Ideally, this research will inform the development of larger clinical trials, paving the way for efficacy-focused studies on HVB as a therapeutic modality. Additionally, this first step of (breath)work will help meet growing interest in nonpharmacological alternatives for inducing ASCs, in the form of our own breath.

Introduction

High ventilation breathwork (HVB), mind-body practices which increase respiratory rate and/or depth, has been used to relieve various forms of psychological distress for millennia. Recently HVB has started receiving an unprecedented surge in public interest owing to its potential to induce altered states of consciousness (ASCs) and improve mental/physical health. Psychoactive substances represent one way to evoke ASCs but unquestionably not the only one[1]. Whilst there has been an explosion in psychedelic research in the West, ancient cultures across the globe have used physical challenges to evoke ASCs in ceremonial settings, i.e., extreme temperatures, fasting and sleep deprivation. However, arguably the most accessible of which is HVB—techniques that are observed worldwide and have complex historical roots grounded in both religious and secular traditions [2]. Such practices have been used since time immemorial for spiritual and healing purposes, being frequently described in the rituals of many cultures [2]. This proposed research aims to meticulously explore the phenomenological effects of HVB. With thoughtfully curated set and setting, HVB has been reported to elicit profound mystical experiences and ASCs akin to those evoked by psychedelics [1,3], including medium to high doses of psylocibin [4]. Current research on ASCs has predominantly focused on pharmacological methods, however there is a growing interest in nonpharmacological approaches, which are often more accessible and culturally acceptable. This also removes medical, legal and financial barriers [1].

Our Lab has started characterising phenomenological and neurophysiological effects of HVB to inform its mechanism of therapeutic action, safety profile and future application. Clinical observations and data from neurophysiological studies indicate that HVB is associated with extraordinary changes in subjective experience, and profound effects on central and autonomic nervous systems functions through modulation of neurometabolic parameters and interoceptive sensory systems [2]. Nondrug alternatives for eliciting and working with ASCs are needed, as many individuals wish to derive therapeutic benefit via experiencing psychedelics’ effects without the need to ingest substances. Breathing provides a potential resource that we have at our disposal (here and now) for improving wellbeing, and its consciousness expanding effects can be stopped at any point by simply returning to a normal cadence. With HVB we are not solely relying on an external source in the form of a drug compound, but our own innate inner capacity for healing. However, like psychedelics, as HVB becomes increasingly popular, it is extremely important that the hype is grounded in—and calibrated with—robust research evidence. This translates to rigorous clinical testing.

Motivation

Despite ancient and modern use paired with countless anecdotal evidence of its profound effects, empirical research on HVB is limited [2]. No published study has yet examined the effects of HVB on ASCs through an RCT. To put the ASC field in perspective, only data from one published HVB study [3] are currently listed on the Altered States Database* [5], an open-science project based on systematic literature reviews, for an established psychological measure of ASCs, in comparison to 28 entries on psylocibin. Moreover, there are no published data on HVB for an established psychological measure of mystical experiences on the Altered States Database, but there are 27 entries for psylocibin. Most breathwork research at present has been on slow-paced techniques [6,7], however the field of HVB is currently in its infancy [2,8].

*The database is powered by the Collaboration for Interdisciplinary Research on Conscious Experiences (CIRCE).

Impact/Significance

Such (breath)work has the potential of helping pioneer a new therapeutic modality in the form of the breath, a tool which can be accessed by anyone instantaneously. This may pave the way for larger, robust RCTs on HVB to occur. In doing so, at a societal level, we could help establish HVB as an accessible, low-cost nondrug alternative for expanding global consciousness. Large-scale robust clinical testing is a necessary step for the evolution of HVB if it is to be integrated into healthcare systems across the world. The perturbed psychophysiological state induced by HVB may also have broader applications regarding how it can be harnessed in a therapeutic context. Deeper knowledge of the ASCs induced by HVB—through rigorous testing of its effects—may deliver societal benefit, in a time where raising global consciousness is needed most. This research represents a step to doing just that.

Hypotheses/Aims

The research objectives of this first pilot RCT on HVB are threefold:

Determine whether a study of this kind on HVB is feasible (to pave the way for a larger clinical trial)
Investigate potential differences in ASCs induced by HVB and slow breathwork
Examine whether HVB, as delivered in this study, induces ASCs comparable to psychedelics (via the Altered States Database)

Materials/Methods

Unlike slow breathwork, high ventilation breathwork (HVB) has not been exposed to the same level of robust clinical testing to date [2,6-8], a necessary step to realise its potential application as a therapeutic modality. We will conduct the first randomised-controlled trial (RCT) of HVB on altered states of consciousness (ASCs). This will take the form of a pilot/feasibility study wherein participants are randomised to in-person, guided HVB or a slow breathing group.

Study type

This will be an experimental study, where participants are randomly assigned to a HVB intervention or slow breathwork. This will be a small-scale pilot RCT for feasibility purposes, hopefully leading to a large-scale clinical trial in the future (depending on funding).

Existing data

Registration prior to creation of data: As of the date of submission of this research plan for preregistration, the data have not yet been collected, created or realised.

Data collection procedures

Quantitative data: The primary outcomes will be ASCs as measured by the 11-Dimension ASC Rating Scale (11D-ASC) [9] and the Mystical Experience Questionnaire (MEQ) [10].

Secondary outcomes include: the Psychological Insight Questionnaire (PIQ) [11], Emotional Breakthrough Inventory (EBI) [12], Depression Anxiety Stress Scales (DASS) [13], and Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) [14]. There will also be optional open-ended responses on overall experience of the breathwork.

The following state measures will be completed immediately after the HVB and slow breathwork sessions: 11D-ASC, MEQ, PIQ, and EBI. The following trait measures will be completed one week before and one week after the breathwork sessions: DASS and WEMWBS.

Qualitative data: Optional open-ended responses will capture participants’ experiences during and after the breathwork sessions.

Sample

Given this is a pilot/feasibility study, 24 participants (12 per group) will be recruited. Participants will be comprehensively screened and the inclusion criteria will be adults with experience of HVB and living in the Brighton (UK) area.

Given the nature of HVB, the comprehensive exclusion criteria are as follows: -Hypotension or hypertension (low or high blood pressure), -History of respiratory or cardiovascular/heart problems or disease, -History of fainting or syncope, -Epilepsy or seizures, -History of panic disorder or panic attacks, Cerebral aneurysm, -Have had problems with prior breathwork sessions (i.e., fainting), -Pregnancy or think one might be pregnant, trying to get pregnant, or are breastfeeding, -Any problems which affect one's ability to pace their breathing, breathlessness, abnormally slow breathing (bradypnea), or abnormally fast breathing (tachypnoea), -Any other physical/mental health conditions or current life events which impair or affect one’s ability to engage in activities involving breath control, -Taking any regular medication other than the contraceptive pill, including medications to reduce blood pressure (i.e., Ramipril or other ACE-inhibitors), beta blockers (i.e., Propranolol), antidepressants, anxiolytics, or any other psychotropic medications.

Processing and Analysis Plan

Quantitative: Data will be analysed using statistical methods to compare the effects of HVB with slow breathwork and other ASC-induction methods documented on the Altered States Database, such as psylocibin. The state outcomes will be analysed using simple quantitative analyses (i.e., unpaired t-tests), whilst the trait outcomes will be analyses using repeated-measure analysis of variance (ANOVA). Simple content analysis will be used to analyse any qualitative responses.

Approximate timeline

Frequent updates on progress will be provided via social media and ResearchHub. Below is an estimated quarterly timeline (with writing plans in parentheses):

-Months 1-3: Protocol development, ethical approval and clinical trial pre-registration. (Draft Introduction section of novel research paper).

-Months 4-6: Advertisement, recruitment and comprehensive screening. (Draft Methods section of paper).

-Months 7-9: Intervention delivery and data collection (Finalise Introduction and Methods by the end of the third quarter).

-Months 10-12: Data analysis, final writing up and submission for publication. (Draft and finalise Results and Discussion sections, so paper is submitted as a preprint by the end of the 12 months).

-Onwards: Wider dissemination of findings to both scientific community and general public (i.e., media/news outlets, podcasts, talks, conferences, workshops, etc.) and, depending on (long-term) funding (see ‘Scaling the BreathworkLab’ below), gear up to conduct large scale clinical trial.

Budget

-Full-time postdoctoral researcher (lowest grade [7.1]) for one year: $49,400

-Breathwork intervention related costs: $600

Other

About me

Breathwork Researcher at Brighton & Sussex Medical School (BSMS)
Breathwork helped me heal from chronic fatigue syndrome and I now wish to share knowledge of breathwork with the world
First UK Doctoral Fellow of The Ryoichi Sasakawa Young Leaders Fellowship Fund, Tokyo
Formed collaborations with Oxford University, UCSF, Imperial College London, and Maastricht
Trained Breath Teacher with The Breath Body Mind Foundation, New York
Conducted two of the largest RCTs on slow and fast breathwork to date
Founded Brighton & Sussex Breathwork Lab, and want to scale this to form a Breathwork Centre dedicated to research and practice
Keynote speaker at Karol Szymanowski Academy of Music Conference– Breath, Music, and Music Therapy
Research featured across the BBC, Guardian, Forbes, HubermanLab, various other platforms, and playing a key role in documentary Air Hunger (filmed at BSMS)
Breathwork meta-analysis in Nature Scientific Reports Journal Top 100 of ‘23 Collection (#5) and Psychology Top 100 (#3)—in top 1% of all research outputs (25M+) tracked by Altmetric (120K+ downloads).
twitter/X: @breath_Guy | website with publications: www.breev.in

Scaling the BreathworkLab

In an ideal case, greater long-term funding will help build and scale our breathwork lab to form a Breathwork Centre, bringing modern science to this ancient body of practices used for millennia. We (myself, my mentor Dr Alessandro Colasanti MD, and Brighton & Sussex Medical School team) have started characterising phenomenological and neurophysiological effects of HVB to inform its mechanism of therapeutic action, safety profile and future application [2]. We are at the forefront and cutting-edge of breathwork research as Colasanti completed the first MRI study (not yet published) on cerebral haemodynamic correlates of ASCs induced by HVB (which I participated in–this is how I met Colasanti and the team). He also assisted some of the earliest imaging research on psilocybin at Imperial [15]. Along with further investigating HVB inducing changes in consciousness state in healthy volunteers and examining physiological parameters/safety, we wish to research HVB as a potential treatment for veterans with PTSD (the population Colasanti cares for at the OpCourage Veterans Mental Health service). We also have several other novel directions we wish to pursue: Conducting the first systematic review on the psychophysiology of HVB, comprehensively characterising its neurophenomenological profile via imaging and qualitative micro-phenomenological study, meticulously quantifying the experience (creating a measure specific to HVB, not psychedelics), exploring different HVB dosages, and mitochondrial remodelling as a result of neurometabolic modulation through HVB. Ultimately, we want to create infrastructure for future cohort/longitudinal studies examining myriad forms of breathwork and their psychophysiological effects over time.

Suitability of Sussex

The University of Sussex, specifically Brighton & Sussex Medical School (BSMS) and Sussex Centre for Consciousness Science (SCCS), offers an ideal interdisciplinary environment for this research. Sussex is a global leader in breathwork research. Led by Dr Colasanti, BSMS conducted the first MRI and altered states of consciousness (ASC) study on high ventilation breathwork (HVB). During the first year of my Psychology PhD I participated in this, which profoundly influenced my research. Additionally, under the direction of consciousness expert Professor Anil Seth, SCCS is a world leader in consciousness studies. The track record of BSMS and SCCS in pioneering ASC research and their commitment to nonpharmacological approaches align perfectly with this project's goals. Sussex's strong emphasis on innovative, interdisciplinary research and excellent facilities will significantly enhance this project's feasibility and impact. Not only is Sussex the most ideal UK institution for this (breath)work, but it is the most ideal institution in the world.

Long-term potential

All of our proposed research has the potential of helping pioneer a new therapeutic modality in the form of the breath, a tool which can be accessed by anyone instantaneously. With breathwork we are not relying on an external psychoactive substance, or medication, but tapping into our own innate inner capacity for healing. In doing so, at a global level, our work could help establish HVB as an accessible, nondrug alternative for shifting consciousness and improving health. Moreover, we will be better able to clarify both the phenomenological and physiological states that arise during HVB in addition to its safety profile, a necessary step for the evolution of HVB if it is to be integrated into healthcare systems across the world. The perturbed psychophysiological state induced by HVB may also offer broader applications to a wide range of fields regarding how it can be harnessed in a therapeutic context. Ultimately, via rigorous clinical testing, deeper knowledge of HVB and its proposed mechanisms and effects could deliver societal benefit, in a time where raising and elevating global consciousness is needed most. Our proposed (breath)work represents steps to doing just that.

References

Havenith, M., Leidenberger, M., Brasanac, J., Corvacho, M., Figueiredo, I. C., Schwarz, L., ... & Jungaberle, A. (2024). Decreased CO2 saturation during circular breathwork supports emergence of altered states of consciousness. PsyArXiv preprints. [Reviewed by me on ResearchHub].
Fincham, G. W., Kartar, A., Uthaug, M. V., Anderson, B., Hall, L., Nagai, Y., ... & Colasanti, A. (2023). High ventilation breathwork practices: An overview of their effects, mechanisms, and considerations for clinical applications. Neuroscience & Biobehavioral Reviews, 105453.
Lewis-Healey, E., Tagliazucchi, E., Canales-Johnson, A., & Bekinschtein, T. A. (2024). Breathwork-induced psychedelic experiences modulate neural dynamics. Cerebral Cortex, 34(8), bhae347. [Preprint version reviewed by me on ResearchHub]
Bahi, C., Irrmischer, M., Franken, K., Fejer, G., Schlenker, A., Deijen, J. B., & Engelbregt, H. (2024). Effects of conscious connected breathing on cortical brain activity, mood and state of consciousness in healthy adults. Current Psychology, 43(12), 10578-10589.
Prugger, J., Derdiyok, E., Dinkelacker, J., Costines, C., & Schmidt, T. T. (2022). The Altered States Database: Psychometric data from a systematic literature review. Scientific data, 9(1), 720.
Fincham, G.W., Strauss, C., Montero-Marin, J. and Cavanagh, K., 2023. Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials. Scientific Reports, 13(1), p.432.
Fincham, G.W., Strauss, C. and Cavanagh, K., 2023. Effect of coherent breathing on mental health and wellbeing: a randomised placebo-controlled trial. Scientific Reports, 13(1), p.22141.
Fincham, G.W., Epel, E., Colasanti, A., Strauss, C. and Cavanagh, K., 2024. Effects of brief remote high ventilation breathwork with retention on mental health and wellbeing: a randomised placebo-controlled trial. Scientific Reports, 14(1), p.16893.
Studerus, E., Gamma, A., & Vollenweider, F. X. (2010). Psychometric evaluation of the altered states of consciousness rating scale (OAV). PloS one, 5(8), e12412.
Barrett, F. S., Johnson, M. W., & Griffiths, R. R. (2015). Validation of the revised Mystical Experience Questionnaire in experimental sessions with psilocybin. Journal of psychopharmacology, 29(11), 1182-1190.
Davis, A. K., Barrett, F. S., So, S., Gukasyan, N., Swift, T. C., & Griffiths, R. R. (2021). Development of the Psychological Insight Questionnaire among a sample of people who have consumed psilocybin or LSD. Journal of Psychopharmacology, 35(4), 437-446.
Roseman, L., Haijen, E., Idialu-Ikato, K., Kaelen, M., Watts, R., & Carhart-Harris, R. (2019). Emotional breakthrough and psychedelics: Validation of the Emotional Breakthrough Inventory. Journal of psychopharmacology, 33(9), 1076-1087.
Lovibond, S.H. & Lovibond, P.F. (1995). Manual for the Depression Anxiety & Stress Scales. (2 Ed.) Sydney: Psychology Foundation.
Ng Fat, L., Scholes, S., Boniface, S., Mindell, J., & Stewart-Brown, S. (2017). Evaluating and establishing national norms for mental wellbeing using the short Warwick–Edinburgh Mental Well-being Scale (SWEMWBS): findings from the Health Survey for
England. Quality of Life Research, 26, 1129-1144.
Carhart-Harris, R. L., Erritzoe, D., Williams, T., Stone, J. M., Reed, L. J., Colasanti, A., ... & Nutt, D. J. (2012). Neural correlates of the psychedelic state as determined by fMRI studies with psilocybin. Proceedings of the National Academy of Sciences, 109(6), 2138-2143.

Airways to Alteration

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