Clinical Research Directory

Open Trial of Biofeedback for Respiratory Symptoms

Biofeedback is a therapeutic paradigm that teaches patients how to gain awareness and control over previously unrecognized sympathetic changes such as body temperature, blood pressure, and heart rate. We propose to use a six session biofeedback protocol that includes heart-rate variability (HRV) biofeedback, respiration/relaxation training, and body temperature control to treat patients with unaddressed respiratory symptoms (e.g. shortness of breath) who are under the care of pulmonologists and have not responded to traditional biomedical approaches (e.g. inhalers, pulmonary rehab, etc.).

Training Strategies to Maintain Performance

• Statement of the Problem and Justification Cognitive performance under physiologically stressful conditions is critical in high-demand environments such as military operations, diving, and firefighting. One such stressor is restricted breathing, which can occur due to equipment (e.g., masks, regulators) or environmental pressures (e.g., underwater). Restricted breathing has been shown to increase physiological strain, which may in turn impact attention, reaction time, and task execution. Despite this, there is limited research examining how different breathing strategies can mitigate the cognitive effects of restricted respiration. Understanding whether specific breathing techniques can preserve cognitive function under stress has practical implications for operational readiness, safety, and task performance in extreme or demanding environments. • Synopsis of Relevant Research Previous human studies have shown that controlled breathing techniques, such as tactical or box breathing (inhale-hold-exhale-hold patterns), can reduce anxiety and improve focus in stressful situations. For example, tactical breathing has been adopted in military and law enforcement settings to enhance performance under pressure. Other research in sports psychology and respiratory therapy suggests that altering breathing frequency or depth can modulate autonomic nervous system activity, potentially affecting cognitive control and reaction time. Additionally, psychomotor vigilance tasks (PVTs) have been widely used to assess the impact of physiological stressors - such as sleep deprivation, hypoxia, and fatigue - on sustained attention and reaction time. However, few studies have directly examined the interaction between structured breathing patterns and PVT performance during restrictive breathing loads. • Importance and Next Step This study represents a logical next step in understanding how breathing techniques can buffer against cognitive decline under conditions that simulate real-world respiratory restriction (e.g., underwater diving). By directly comparing the effects of two distinct breathing strategies during a controlled, restrictive breathing task, this research will help determine whether certain techniques are more effective in preserving attention and reaction time. The findings could inform training and operational protocols for individuals working in challenging environments, as well as guide future studies into breathing-cognition interactions under physical stress.