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Hi! I'm Kenzie. I'm 16 years old and I have struggled with anxiety for as long as I can remember. I launched "Cheaper Than Therapy" because I want people to know that traditional talk therapy is not the only way to overcome anxiety.

The DSM-5 is the most recently updated version of the Diagnostic and Statistical Manual by the American Psychiatric Association. The DSM-5 is used to diagnose and define various mental disorders, including anxiety disorders.

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Hi! I'm Kenzie. I'm 16 years old and I have struggled with anxiety for as long as I can remember. I launched "Cheaper Than Therapy" because I want people to know that traditional talk therapy is not the only way to overcome anxiety.

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"7 Tips On How to Stop Intrusive Thoughts" (Website) 

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"7 Tips On How to Stop Intrusive Thoughts" (Website) 

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Credible Website

Summary:
This source is a post by NorthPoint Recovery, a rehab center for addiction and a partial hospitalization program for other mental health disorders. This particular article focuses on defining intrusive thoughts and providing readers with several suggestions on how to overcome them, including self help strategies and cognitive behavioral therapy.

Application:
I used this source to gain a better understanding of intrusive thoughts and how to minimize them. I cited this source in my post on intrusive thoughts on my website.

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Every day, we are at risk of experiencing intrusive thoughts. With thousands of thoughts per day, sometimes we don't even realize they are there. The intrusive thoughts are the ones that are disturbing enough, we focus our attention to them.

Our everyday life concerns make up 67% of our thoughts. We experience 18% of thoughts that are bad, unacceptable or not comfortable to deal with. Disturbing intrusive thoughts make up 13% of our daily thought processes.

Intrusive thoughts are normal. We all experience them. They are unwanted thoughts or images that can cause you to become obsessed or distressed. You may have a difficult time managing an intrusive thought and getting past it. While they are no different from any other thought, it's our attachment to it that causes the real disturbance.

While we do all experience common intrusive thoughts, some are more affected by them. Complex PTSD or OCD intrusive thoughts can wreak havoc on someone's life. When an intrusive thought occurs, it can result in disturbances that are hard to manage.

What Are Intrusive Thoughts?

You may be wondering, "What are intrusive thoughts anyway?"

Invasive thoughts and intrusive thoughts are normal. We all experience them. They are unwanted thoughts or images that pop into your head without reason and can cause you to become obsessed or distressed. You may have a difficult time managing an intrusive thought and getting past it. While they are no different from any other thought, it's our attachment to it that causes the real disturbance.

While we do all experience common intrusive thoughts, some are more affected by them. Complex PTSD or OCD intrusive thoughts can wreak havoc on someone's life. And when an intrusive thought occurs, it can result in disturbances that are hard to manage if you don't know how to deal with intrusive thoughts.

Invasive thoughts may take the form of fears of the future, intrusive memories from the past, inappropriate thoughts (e.g. sexual intrusive thoughts), intrusive images, and a variety of other disturbing thoughts as well.

Ultimately, intrusive and invasive thoughts are absolutely normal. In fact, some studies have shown that a whopping 94% of the population experience unwanted thoughts that are intrusive and unpleasant on a daily basis.

It's when these intrusive thoughts become obsessive that the real damage is done.

Obsessive Thoughts vs. Intrusive Thoughts

There's an important distinction between obsessive thoughts and intrusive thoughts.

Intrusive thoughts (a.k.a. invasive thoughts) are just as they sound. They seem to appear out of almost nowhere and may be disturbing thoughts that are sexual, violent, fear-based, or inappropriate in nature.

What causes intrusive thoughts has always been a bit of a mystery. But some researchers link these unwanted and invasive thoughts to an imbalance of a brain chemical known as GABA, responsible for inhibiting activity of certain cells in the mind.

And while they can be jarring, they usually aren't a sign of an underlying disorder unless they're severe or incredibly persistent.

It's when these invasive thoughts (and thinking about those thoughts) starts to negatively impact normal functioning that they should be a cause for concern.

If, for example, you are so grappled by fear about driving that you walk 5 miles to work every day, it could be a sign of a problem. Or if you're bombarded by intrusive thoughts throughout the day that you left the stove on so you check it every 15 minutes and can't leave the house, you may be too fixated on these unwanted thoughts.

These kinds of intrusive thoughts and the behaviors they cause can be thought of as obsessive thoughts - because you literally find yourself obsessed with and unable to move on from them.

Obsessive thoughts, then, are often indicative of an underlying problem and could point to obsessive-compulsive disorder.

So while it may be a waste to wonder how to stop intrusive thoughts since they're just a part of being human, knowing how to stop obsessive thoughts can be the key to living a healthy, functional life.

Common Intrusive Thoughts List

Here are a few examples of intrusive thoughts:

Fear-based thought that you might do something inappropriate or embarrassing.

Fear-based thought that you've got a disease with no basis to support it.

Flashback to unpleasant things from your past. (Ex. intrusive memories PSTD).

Inappropriate thoughts or images of sex.

Thoughts of committing illegal or violent acts.

A thought that if you don't do something, you might ruin your luck.

Intrusive thoughts and OCD are commonly connected but it's not always the case. In fact, the vast majority of people experience intrusive thoughts on a daily basis.

Fixating on these intrusive thoughts and being unable to let them go, however, can be problematic.

So, if you're wondering, "Are intrusive thoughts normal?"

The answer is yes - it's when they become obsessive thoughts that you need to start worrying.

OCD and Intrusive Thoughts

If you're suffering from OCD, intrusive thoughts can cause you to overreact. At a cellular level, the brain sends signals that something is wrong and it needs to be tended to right away. And while it may be clear to others that these fears and obsessive thoughts are unfounded and many intrusive OCD thoughts are not real, to the person experiencing them, the fear and dread are as real as can be.

The fears that develop through the thoughts happen only with things that are important to the person. The basis is different for every OCD patient.

Intrusive thoughts from OCD examples include fear of loss in the family, fear of being killed or killing someone else, and other intense end results. For someone who is nonclinical OCD, intrusive thoughts affect them much less. The level of emotional distress resulting from thoughts is a criterion for OCD.

The intrusive thoughts of OCD may also contribute to the development of agoraphobia or severe social anxiety which can make leaving the house almost impossible.

If you're suffering from intrusive thoughts from obsessive-compulsive disorder, you're probably wondering just how to get rid of OCD and stop intrusive thoughts from taking over your life.

However, there usually isn't an easy fix. Like treating PTSD, some of the best methods of overcoming overwhelming fears and obsessions is through cognitive-behavioral therapy (CBT). These treatments force patients to rationally focus on their thoughts, feelings, and behaviors and observe how they relate.

The most well-documented type of CBT for OCD is Exposure and Response Prevention (ERP) according to the International OCD Foundation.

In the end, though, getting professional treatment is often the absolute best way of finding out how to overcome OCD intrusive thoughts.

Intrusive Thoughts and Depression

When you feed into intrusive thoughts, it can lead to depression. Each mood disorder has its own set of intrusive thought patterns. This makes it challenging to get out of the hole of depression.

Depression and constant thinking are closely connected to one another. Depression causes thought processes that are more prone to be negative, sad, hard to manage, and exhausting.

Those who are depressed will feed into these intrusive thoughts and fall deeper into a hole. Self-analyzing will cause them to find flaws in themselves and welcome further negative thinking.

Intrusive thoughts have to be managed in order for the person to get through their depression. Beating out intrusive thoughts is extremely difficult when a person is already depressed and the two will feed off one another. Medical and Psychiatric services may be helpful.

As you can probably guess, intrusive thoughts and anxiety often go hand-in-hand as well. The incessant and overwhelming fear that comes with obsessive thoughts can lead to the development of a crippling anxiety disorder that can make it incredibly hard to function on a day-to-day basis.

Beyond that, the overwhelming anxiety these intrusive thoughts can cause can eventually lead sufferers to turn to substance abuse and eventually addiction in order to cope with the condition.

Intrusive Thoughts and Negative Impact on Addiction

Some may manage intrusive thoughts with compulsive coping mechanisms which can include alcohol or drug abuse. In an effort to not cope with unwanted thoughts, a person may take part in destructive behaviors. Trying to stop the feelings altogether can cause a person to chronically use drugs or drink, leading to addiction.

In a study by the Journal of Anxiety Disorders, they estimate that over 25% of patients with OCD meet the criteria for a substance abuse disorder. Most OCD symptoms begin to occur in childhood or early adolescence and cause the development of drug or alcohol problems.

Having to cope with intrusive thoughts can cause depression, anxiety, and irrational fears. When treating an addictive disorder in someone who has OCD, it's imperative to also treat emotional symptoms of OCD.

Treating the gamut of mood disorders that occur with addiction (depression, anxiety, etc.) as well as OCD at the same time as when you treat your substance abuse disorder is essential. When these mental disorders are treating individually, the disorder left untreated can often cause a relapse soon after.

For instance, if you go into addiction treatment without treating your OCD, the obsessive thoughts of your OCD will make it much harder to abstain from using once you get out of the rehab program.

This is what's known as "dual diagnosis" - when a substance addiction overlaps with another mental disorder like depression, anxiety, or OCD.

So along with treating addiction, there should be additional treatment like cognitive-behavioral therapy. This helps to cope with emotional triggers that cause compulsive behavior. It also trains the mind to deal with intrusive thoughts differently.

What Does Clinical Intrusive Thoughts Treatment Look Like?

It can be incredibly hard to function when you're plagued by obsessive thoughts every waking minute of your day. And for some, the absolute best option just may end up being professional treatment.

In fact, there often is no better way of learning how to deal with intrusive thoughts than through the guidance of a professional.

Your treatment may include:

Being prescribed the best medication for OCD intrusive thoughts like SRIs which help regulate serotonin.

Group talk therapy

One-on-one counseling

Specialized behavioral therapy like CBT

Experiential therapy

And much more. In general, these treatments will help show you how to stop obsessive thoughts from taking over your life and how to deal with intrusive thoughts functionally rather than letting them take over your world.

7 Tips on How to Stop Intrusive Thoughts

When you allow the thoughts to run your life, you make choices that negatively affect you. How to stop OCD intrusive thoughts depends on the severity of the problem.

If you've already been avoiding the problem for some time, you may also have co-occurrence disorder as a result of negative behaviors. Treatment can be as simple as using intrusive thoughts self-help methods like mindfulness. Others may require medication for intrusive thoughts from OCD along with cognitive therapy.

Here are 7 things you can do to help you not react negatively to intrusive thoughts that come up.

1. Understand Why Intrusive Thoughts Disturb You

Intrusive thoughts latch onto things that mean a lot to you. This is what makes it such a disturbance for your nervous system. It could be your family, animals, your job, or your reputation.

If something pops into your mind that you're hurting an animal when you love them, it's going to get your attention. Alternatively, there are people who hunt animals so the same thought wouldn't be intrusive.

There are many unwanted thoughts running through your mind. It's the ones that go against your core values that become intrusive. An unwanted thought will naturally make you feel fear, disgust, or alarm. If you react negatively, it's going to make the thought seem even stronger.

Understanding your own core values will help you to understand those unwanted thoughts you have. You will understand why they make you feel afraid or why you'd react negatively to them.

Eventually, you can turn these obsessive thoughts into ones you can simply move on without.

2. Attend the Intrusive Thoughts

You can minimize the damage of intrusive thoughts with self-help. This includes being mindful in the wake of an intrusive thought. In the moment of an unwelcome thought, you might react to them as though they're real. You may incessantly fear that you'll act upon these obsessive thoughts.

Accepting intrusive thoughts is the key to dealing with them. They no longer mean anything to you when you acknowledge them.

Don't try to figure out what it all means or use tactics to avoid causing harm to others. This causes your mind to pay extra attention to the intrusive thoughts, which is the last thing you want. How to get rid of intrusive thoughts is to see them come through you and move on.

3. Don't Fear the Thoughts

One of the coping mechanisms for dealing with intrusive thoughts can include avoidance. Commonly you'll avoid these intense thoughts because you don't know how to deal with them. When intrusive thoughts are fear-based, it's key not to push it away.

Talk yourself down and tell yourself its fine. Accept that the obsessive thought is there and don't try to resist the experience. You may feel tension all throughout your body but it will pass. Trying to run and hide from a fearful thought with your own feelings of fear qualifies it.

4. Take Intrusive Thoughts Less Personally

OCD thoughts are not real and yet we tend to believe them to the extent that we'll apologize for something that never happened. It's important not to take the thoughts you have as the person you are. An emotional reaction to how you think just keeps the thought alive.

Letting go of thoughts is something we do all the time. It shouldn't differ when it's a disturbing thought. You know that these intrusive thoughts are not likely to happen. Find the deeper sense of trust in yourself.

You can reason with yourself by saying,

"This thought could become a reality but the chances are pretty slim. I won't worry about it right now. Everything is okay at this moment."

5. Stop Changing Your Behaviors

Compulsive behavior can manifest when you try to change who you are based on the intrusive thoughts you experience. OCD thoughts are not real so changing your reality to try to work around it is not a solution.

Compulsions are mental behaviors you'll do to get some kind of comfort or certainty about these thoughts. Somewhere in your mind, you believe that obsessive hand washing is how to get rid of bad thoughts forever.

You may change your life around too. If you have intrusive thoughts about kids, you may avoid parties for example. You can't avoid triggers of these obsessive thoughts. This strategy just keeps the cycle going.

6. Cognitive Therapy for Treatment of OCD Intrusive Thoughts

Those with intrusive thoughts from OCD or complex PTSD intrusive thoughts benefit from mindfulness exercises but usually require treatment past self-help also. Cognitive Behavioral Therapy (CBT) has shown to be 70% effective in patients with OCD.

Through CBT, patients have to deal with their fears which helps alleviate the compulsions. It's essentially a treatment of detoxing the mind holistically. A modified CBT approach for intrusive thoughts include:

Taking a self-report questionnaire like an OCD intrusive thoughts test.

Role-play simulation with electronic cueing.

Determining the thought process a person goes through.

Refocus the brain through mental education.

Gathering evidence to challenge the deep beliefs the patient has.

Intentional thought exposure.

Situational exposure.

Non-judgemental acceptance.

7. Medications that Help with Intrusive Thoughts

OCD ruminations and anxiety are closely linked. If a medication can make you less anxious, it's likely to lower the desire to ruminate.

Anxiety = Ruminations = Panic = Depression

Intrusive thoughts are harmless but have the ability to cause harm based on your reaction to them. Sometimes, it's not possible to control the impulses or handle the anxiety that occurs with invasive or intrusive thoughts.

Medication for intrusive thoughts comes with mixed reviews. There is opportunity to relax the nervous system and help with holistic development. It can, on the other hand, causing prescription drug addiction, worsening the situation.

Anxiety medication for intrusive thoughts can calm your reaction to the thoughts. In OCD patients, this can help them alleviate triggers that cause their obsessive behaviors. The heightened nervous state leading to the fight or flight response leads to less sleep and unhealthy choices. Removing anxiety from your life will allow you to experience less obsessive thoughts that evolved from intrusive thoughts.

In general, a specific type of medication called serotonin reuptake inhibitors or SRIs have been found to be the best medication for OCD intrusive thoughts and other symptoms of OCD. The anxiety and depression that often come with obsessive thoughts and the resulting fixation tend to be far more manageable with these drugs.

Zoloft does work well as intrusive thoughts treatment indirectly in OCD patients, helping to manage the rituals, repetition, and senseless behavior. While Zoloft can't prevent intrusive thoughts, which is a natural part of our cognitive functioning, it can help you manage the aftermath. This is the same story with Buspar for intrusive and obsessive thoughts.

There have been reviews regarding Prozac for intrusive thoughts medication that say their symptoms became worse. Others said that it helped them relax and get rid of disturbing thoughts.

The Right Treatment for Intrusive Thoughts

Intrusive thoughts happen to everyone. It's how you cope with them that defines how much they'll rule your life. For some, many phases have built up through time, creating an uncontrollable compulsion to avoidance or reacting to the thoughts.

It's important that even if you're taking medication for intrusive thoughts that you also learn how to manage intrusive thoughts as well. This learned habit can be done through cognitive-behavioral therapy and other proven treatments.

The various effects that intrusive thoughts have on people means that the treatment for intrusive thoughts vary as well. For those trying to recover from addiction, intrusive thoughts can plague the person, making it more difficult to overcome. Those with OCD or PSTD may not be able to overcome the thoughts without professional treatment and intrusive thoughts anxiety medication.

In the end, it's absolutely crucial that you work with a professional to find out how to stop intrusive thoughts in your particular situation.

Frequently Asked Questions

What Causes Intrusive Thoughts?

Are Some Intrusive Thoughts Normal?

How do Professionals Diagnose Intrusive Thoughts?

When Should I Start to Worry About Having Intrusive Thoughts?

What is a Common Myth About Intrusive Thoughts?

What Could Happen if I Ignore Recurring Intrusive Thoughts?

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7 Tips on How to Stop Intrusive Thoughts

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Every day, we are at risk of experiencing intrusive thoughts. With thousands of thoughts per day, sometimes we don't even realize they are there. The intrusive thoughts are the ones that are disturbing enough, we focus our attention to them. Our everyday life concerns make up 67% of our thoughts.

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"Guided Meditation: A regimen for mental health" (Academic Journal) 

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"Guided Meditation: A regimen for mental health" (Academic Journal) 

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Peer Reviewed Article

Summary:
This source is an article published in the Indian Journal of Health and Well Being in 2017. The journal is published by the Indian Association of Health, Research, and Welfare. This particular article discusses the general benefits of meditation for mental health and specifically discusses the benefits of guided meditation for beginners.

Application:
I used this source to gain an understanding of why guided meditation specifically is more effective for people suffering from anxiety than general meditation. I learned that guided meditation is especially helpful because it offers clear instructions toward a clear purpose. I used this source to back up a post on my website about guided meditation.

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"Language Matters in Mental Health" (Website) 

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"Language Matters in Mental Health" (Website) 

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Credible Website

Summary:
This source is an article on the website of the Hogg Foundation, an accredited mental health foundation run bu the University of Texas. The Hogg Foundation works to improve the way that communities approach mental health issues. This particular article discusses subtle changes in language that can be made to help people experiencing mental illness feel more accepted and human.

Application:
I used this source for information on People-First language for my informational article on my website on this topic. I decided to include a section on "People-First Language" on my blog because although my primary audience is people living with mental illness, a secondary audience is the support people of people with mental illness. I hope that my section on People-First Language will help the family and friends of people living with mental illness to consider their language more carefully.

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Language shapes how we see the world. The words we choose and the meanings we attach to them influence our feelings, attitudes and beliefs. Our language choices have a powerful effect on how we view mental health and people living with mental health conditions.
"Words can inspire. And words can destroy. Choose yours well." - Robin Sharma
Everyone deserves to be treated with respect. Respectful language emphasizes the person, not the condition or disability. It's a way to demonstrate respect for a person's dignity and worth. This is sometimes called person-first language.

We talk about the health condition only when necessary. Before choosing your words, ask yourself if labeling someone with a mental health condition matters in the conversation. A person's mental health is only one aspect of who the person is. If the information doesn't contribute to the conversation in a necessary or meaningful way, why mention it at all?

Labelling can be harmful, but in some circumstances it may be necessary. If it is important, then use respectful language, which literally means putting reference to the person first in a phrase. For example, instead of calling someone "mentally ill," a more respectful, people-first way of phrasing it is to say "a person living with a mental health condition."

Don't Say This

Say This When Necessary

That's crazy, psycho, insane, nuts

That's wild, bizarre, odd, eccentric

It drives me crazy

It annoys me

Patient, client, case

An individual needing mental health services

He is a paranoid schizophrenic
She's an anorexic
He's depressive
She's OCD
He's bipolar
She's mentally retarded

He has paranoid schizophrenia
She has anorexia nervosa
He has major depression
She has obsessive-compulsive disorder
He has bipolar disorder
She has an intellectual or developmental disability

She is emotionally disturbed

She has a serious emotional condition

He's a special education student

He's a student receiving special education services

She's an addict or substance abuser

She has a substance use disorder

He's mentally ill

He has a mental health condition or diagnosis

Super utilizers, High-needs adults

Individuals with complex support and service needs

Successful suicide
Unsuccessful suicide

Completed suicide
Attempted suicide

Suffering from mental illness

Living with (or experiencing) mental illness

Language is constantly evolving. As times change, the words people prefer also change. To show respect in conversations with others, be mindful of the impact your word choices have. If you need to use a descriptive term but are unsure of the words to use, ask the person how he or she would like to be addressed or referred to.

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Language Matters in Mental Health | Hogg Foundation

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Language shapes how we see the world. The words we choose and the meanings we attach to them influence our feelings, attitudes and beliefs. Our language choices have a powerful effect on how we view mental health and people living with mental health conditions. "Words can inspire. And words can destroy.

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"How to STOP ANXIETY Fast (Easy Technique!) - Stress Relief / EFT / Tapping"(YouTube Video) 

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"How to STOP ANXIETY Fast (Easy Technique!) - Stress Relief / EFT / Tapping"(YouTube Video) 

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Multimedia Source

Summary:
This video is by a YouTuber, Jasmine, on a channel called "Cat Lady Fitness". Jasmine's channel focuses on stress management techniques and other lifestyle videos. In this video, Jasmine walks through and demonstrates tapping, an anxiety management technique which involves tapping various parts of the body and repeating positive affirmations.

Application:
I used this source to provide my audience with a tutorial for tapping. I linked this video in my post "Tales From Therapy", where I explain various techniques and advice that I learned from therapy.

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"Can Coloring Mandalas Reduce Anxiety?" (Academic Journal) 

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"Can Coloring Mandalas Reduce Anxiety?" (Academic Journal) 

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Peer Reviewed Article

Summary:
This source is an article in the academic journal "Journal of the American Art Therapy Association". The American Art Therapy Association is comprised of art therapists form around the world and sets the standards for the profession. This particular article discusses research conducted by Nancy A. Curry and Tim Kasser on the impact of coloring mandalas on anxiety. Curry and Kasser found that coloring any form with geometric complexity reduces anxiety, while coloring on a blank piece of paper increases anxiety.

Application:
I used this research to explain the benefits of coloring mandalas in a post on my website about racing thoughts. I cited Curry's and Kasser's reseach on that particular post.

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"Reminding and mood-congruent memory" (Academic Journal) 

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"Reminding and mood-congruent memory" (Academic Journal) 

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Peer Reviewed Article

Summary:
This research was published in the Bulletin of the Psychonomic Society, a publication of the Psychonomic Study, one of the premier institutions for basic research in experimental psychology in the United States. This article describes a 1983 experiment by Gordon H Bower in which researchers separated happy and sad individuals and then prompted both groups to recall both positive and negative life experiences. Bower found that although both happy and sad subjects could easily recall a happy experience, only 68 percent of happy subjects could recall a sad experience (as opposed to 84 percent of sad subjects). This research shows that when people are not currently experiencing a negative emotion, they will have trouble recalling their experiences of that emotion in the past. This is dangerous in people with anxiety because if people are not able to recall their struggles, they will not be able to relay them to professionals or support people.

Application:
I used this research to decide that I am going to create a post on my website encouraging writing down negative feelings and experiences associated with anxiety, not only to remember them in the future, but also to release the emotions.

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"The Influence of Ambient Scent and Music on Patients' Anxiety in a Waiting Room of a Plastic Surgeon" (Academic Journal) 

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"The Influence of Ambient Scent and Music on Patients' Anxiety in a Waiting Room of a Plastic Surgeon" (Academic Journal) 

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Peer Reviewed Article

Summary:
This article was published in 2014 in the Health Environments Research and Design Journal, a peer reviewed, interdisciplinary journal that publishes research on the effects of health care environments on patient and provider outcomes.
This particular article focused on the effects of calming scents and instrumental music on anxiety.
The field experiment described in this research took place in the waiting room for a German plastic surgeon. Researchers measured the effects of a lavender scent, ambient music, and the two combined on anxiety of patients. Researchers found that although lavender and ambient music together led to over-arousal and did not reduce anxiety, either used separately lowered arousal and anxiety.

Application:
I used this research to decide that I am going to create a post discussing the positive effects of ambient scent and music on anxiety.

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The Influence of Ambient Scent and Music...

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"An Overview of Dissociation Anxiety" (Website) 

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"An Overview of Dissociation Anxiety" (Website) 

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Credible Website

Summary:
VeryWell Health is a reliable online resource partnered with Cleveland Clinic that provides accurate, up-to-date information on various mental and physical health ailments. This particular article focuses on dissociation as a symptom of anxiety. The article summarizes depersonalization (feeling that you are not real) and derealization (feeling that the world is not real) and offers grounding strategies as a remedy for both. These grounding strategies include eating a piece of candy, walking around, and becoming aware of your surroundings.

Application:
I used this source to structure the article on my website regarding dissociation anxiety. I am going to include a grounding exercise in my discussion of dissociation as a symptom of anxiety.

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Dissociation anxiety is not a specific diagnosis or set of symptoms. Rather, dissociation is a symptom, and it may be related to anxiety.﻿﻿

When a person experiences dissociation, they become disconnected from their surroundings or from themselves. This reaction works to temporarily alleviate potentially overwhelming emotional experiences such as traumatic memories and may temporarily reduce feelings of shame, anxiety, or fear (but it does not function as a healthy long-term fix).

Dissociation related to anxiety may occur during a stressful, anxiety-inducing event or during or after a period of intense worry. Because dissociation is based in avoidance coping, it "works" in the short-term but has long-term negative consequences.

What Is Dissociation?

Dissociation refers to being disconnected from the present moment. It is a subconscious way of coping with and avoiding a traumatic situation or negative thoughts.

Dissociation usually happens in response to a traumatic life event such as that which is faced while being in the military or experiencing abuse. In this way, dissociation is usually associated with trauma and post-traumatic stress disorder (PTSD). However, dissociation can also happen in the context of anxiety symptoms and anxiety disorders.

Often, dissociation that happens due to extreme stress or panic is recognized but attributed to other causes such as health issues. A person with panic disorder may seek medical attention for these symptoms and feel powerless to stop them.

Overall, dissociation interferes with the treatment of all types of disorders and makes it hard to pay attention to the present moment. It can also slow or prevent healthy trauma processing and coping. Because of this, it's important to address dissociation through treatment and learning ways to cope.

The process of dissociation usually occurs outside your own awareness, though you may also realize it is happening, particularly if it is in the context of anxiety. The experience involves a disconnection between your memory, consciousness, identity, and thoughts.

In other words, while normally your brain processes events (such as your memories, identity, perceptions, motor function, etc.) together, during dissociation, these parts splinter, leaving you with a feeling of disconnection. Dissociation is a general term that refers to a detachment from many things.

Depersonalization

With depersonalization, your mind feels disconnected from your thoughts, feelings, actions, or body. Examples of this include feeling like you are watching a movie about yourself or that you don't have an identity.

Some of the symptoms experienced as a result of depersonalization include the following:﻿﻿

Alterations in your perceptions

Distorted sense of time

Emotional or physical numbing

Feelings of yourself being unreal or absent

Derealization

Derealization causes a sensation where the world does not feel real. Examples of this include seeing the world all in shades of grey or having tunnel vision when looking at the world.

The symptoms involved with derealization include:﻿﻿

Feeling like the world around you is not real

Feeing the world as flat, dull, or grey

Having tunnel vision when you look at the world

There are three types of dissociative disorders that are diagnosed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, these are separate from dissociation related to anxiety:

Depersonalization disorder: Characterized by ongoing feelings that you are detached from the world around you

Dissociative amnesia: Characterized by trouble remembering events or having amnesia for events due to dissociation

Dissociative identity disorder:Characterized by the presence of two or more distinct personalities and gaps in memory (formerly known as multiple personality disorder)

Again, there is no diagnosis of "dissociation anxiety," although dissociation can be a symptom associated with anxiety disorders. The major anxiety disorders that may be related to dissociation include: ﻿﻿

While the exact cause of dissociation is unclear, experts note that dissociation correlates with mood and anxiety disorders and is also a way of dealing with trauma. As a result, dissociation often affects people who have experienced the following types of trauma:

Accidents

Assault

Natural disasters

Military combat

Sexual or physical abuse

When dissociation is related to anxiety or panic, it tends to occur for a shorter period of time than when it is due to trauma or abuse or as a symptom of a diagnosable dissociative disorder.

In the case of anxiety, it is constant, low-level stress that puts a strain on your nervous system and eventually may cause you to dissociate to protect yourself; but remember, this all happens mostly at a level that you are not aware of.

Although there is no specific treatment for dissociation, medications and psychotherapy have been shown to help.

Medications

While there are no medications to specifically treat dissociation, your doctor may prescribe antipsychotics, antidepressants, or anti-anxiety medications to alleviate some of the symptoms of a dissociative condition.﻿﻿

Psychotherapy

Treatment for dissociation related to anxiety usually will involve psychotherapy (such as cognitive behavioral therapy or dialectical behavior therapy). Eye movement desensitization and reprocessing ( EMDR) is another therapy that is sometimes used.

Since dissociation can interfere with the effectiveness of treatment, your therapist may ask you to do the following things to snap out of a period of dissociation:

Make eye contact.

Eat a piece of candy to snap into the moment.

Get up and walk around for a bit.

Name five animals with letters that match the first five letters of the alphabet.

Name five things you see, hear, and feel.

Smell a particular scent for grounding, such as lavender.

Explain what happened if you look spaced out or recall what you were talking about when you spaced out.

Remember how using spacing out is an avoidance strategy.

The key to managing dissociation related to anxiety is to practice grounding techniques to bring yourself back into the present moment. You can do this by always having a " grounding plan" that you put in place when you find yourself spacing out or otherwise feeling as those you are dissociating.

In other words, the dissociation will stop when your brain no longer feels the need to protect you. Some preventative steps that you can take to manage dissociation related to anxiety include the following:

Get enough sleep each night

Get regular exercise every day

Practice grounding techniques as noted in the treatment section above

Prevent anxiety from becoming overwhelming

Reduce daily stress and triggers

A Word From Verywell

Are you concerned about dissociation anxiety? It could be that you actually have anxiety about your dissociation, rather than dissociation that is simply caused by anxiety.

If you are finding yourself very worried about dissociation symptoms, such as feeling detached from the world or things not feeling real, it's important to speak to your doctor or a mental health professional about how you are feeling and what can be done to help you feel better. Only a professional can determine whether your symptoms are related to trauma or anxiety, or some combination of the two, which will influence treatment.

Finally, if you don't notice dissociation yourself, but others seem concerned about your behavior, it may still be worth seeking help. Dissociation is not always consciously recognized, so you may still be experiencing it.

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Dissociation anxiety is not a specific diagnosis or set of symptoms. Rather, dissociation is a symptom, and it may be related to anxiety.﻿﻿ When a person experiences dissociation, they become disconnected from their surroundings or from themselves.

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Credible Website

Summary:
This site is part of a larger website called "Thervo", a website that matches consumers to professionals in their area and provides cost estimates for various services. According to this website, therapy can cost $60-$250 per 45-60 minute session without insurance.

Application:
I used this website to get an idea of the average cost of therapy for someone without insurance. Based on the fact that $60-$250/session is out of reach for much of my target audience, I decided to share some alternative to therapy and helpful tips that I've learned from therapy on my website.

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Therapist Cost

The average cost of therapy is $60 to $120 per session, with most American's paying between $20 to $250 per hour depending on the number of sessions booked, and if it's covered by health insurance. With health insurance coverage, rates average $20 to $50 per session, or about equal to your current copay.

Addition options such as online therapy costs $40 to $70 per week with a membership plan and typically offers 24-hour support.

Therapy, in all its diverse offerings, has the goal of relieving or healing disorders, mental illness, and of rehabilitating individuals and helping them function better socially. There are many different types of therapy one can sign up for to reach that intended goal, and the cost of the treatment will depend on the accreditation of the mental health professional, your insurance provider, and the methods used.

Table of Contents

How Much Is a Therapist Session?

If you need therapy, it is essential to understand the different ways therapists charge before developing a treatment plan. Mental health professions charge either per hour or per session, with prices fluctuating on a sliding scale based on your income. Community mental health clinics typically cost less than a therapist in a private practice.

The number of sessions you book, where you live, and your health insurance provider can affect your costs. Also, the current status of your mental health issues will determine which type of therapist you'll need to see.

Therapist Rates Per Hour

Therapist rates average $90 per hour with most spending between $60 and $120 per session. If you live somewhere like New York or Los Angeles, standard rates for health providers can jump up to $250 per hour.

Sliding Scale Therapy

Another key variable in regards to therapy rates is whether or not you qualify for sliding scale therapy. For example, if a therapist's standard rate is $150 per hour, if you make less than a set amount (i.e., $60,000 per year), you could benefit from one-hour therapy sessions for as little as $75. Each therapist and practice will set their own sliding scale fees, helping those with fewer resources seek and obtain the help they need.

Does Insurance Cover Therapy?

Across the United States, specific laws such as the mental health parity law require certain health insurance plans to cover therapy for mental health issues, just as they would cover physical ailments. Some insurers are generous with their mental health coverage, while many others require you to pay most of it out of pocket. Those who purchased insurance through the Affordable Care Act have access to some level of mental health care.

Those who obtain insurance coverage through their employers are also often covered. Some therapists participate in insurance networks, so if you typically pay a $50 copay to see your doctor, the cost to see a psychologist will not be any higher. To better understand what you need to pay individually, you should inquire about your current deductibles, copays, and coinsurance, as well as any out-of-pocket costs.

How Much Does Therapy Cost without Insurance?

If you do not have insurance, you can expect to pay the standard rate as set by your local therapist, psychologist, or psychiatrist. As discussed, this rate could be anywhere from $50 to $250+ per hour-session.

How Much Does Therapy Cost with Insurance?

If you currently have health insurance, you may pay as little as $20 to $50 per therapy session if that is what you currently pay in regards to your insurance co-pay rate. In many cases, your insurance company will select a therapist for you. However, you can contact various local therapists to inquire about the insurance companies they work with.

Types of Therapy

If you are seeking treatment for a specific condition or circumstance, here's what you need to know in regards to pricing.

Individual & Private Therapy Cost

The cost of private therapy will depend on where you live and in some cases, how much you make per year. On average, expect to pay at least $150 per hour session, as individual therapy is often the most expensive. If your income is low, you may be able to obtain lower rates.

Couples Therapy Cost

The cost of couples therapy varies depending on the professional you see and where you're located. In general, counselors specializing in couples and family therapy charge between $70 and $250 per hour. Where you reside will impact the price you pay, as standard rates vary across the country. In the San Francisco Bay Area, for example, expect to pay anywhere between $120 and $250 per hour as a couple.

Marriage Counseling Cost

Family and marriage counseling rates range from $70 to $250. Across the country, you can expect to pay an average price of $100 per session for family counseling. When it comes to strengthening the relationship, individual therapy is excellent for addressing personal emotional triggers, but marriage counseling can be invaluable because you get to work through your issues and come up with solutions together rather than take a stand against issues within the relationship on your own.

Group Therapy Cost

Some counseling centers and therapists offer group therapy when they feel that the group's collective experiences can help the individuals in it move forward. Group members encourage each other, grow better communication skills concerning their needs and struggles, and provide an excellent sounding board for their individual thought processes.

If you're aiming to lower the costs associated with counseling, group therapy may be an ideal option. For example, instead of paying $200 per session, multi-session group therapy rates are often available -- which could be as low as $700 per 8-week course.

Depression Therapy

As researchers learn more about depression, it's becoming more apparent that a combination of talk therapy and medication are generally required. In terms of how much depression therapy costs, the final rate will depend on the severity of your depression in relation to your treatment needs.

If you do not have insurance and do not qualify for sliding scale therapy, expect to pay between $100 and $200 per hour to see a psychiatrist. The cost of depression medication will be extra.

Grief Counseling Cost

Grief counseling is typically offered at the same rates associated with psychologists, which is generally between $70 and $150 per hour. Since bereavement does not qualify as a mental health disease, it may not be covered by your insurance plan.

Sex Therapy Cost

Depending on the location in which you seek treatment, sex therapy typically costs between $100 and $200 per hour. Rates will depend on who you choose as your therapist, particularly in regards to their qualifications and expertise.

Average Cost of Anger Management Classes

Depending on where you go to benefit from anger management classes, you will likely pay between $50 and $150 per session. There are various programs available, and in some cases, you can participate in an all-day group anger management program for as little as $200 per day.

Cognitive Behavioral Therapy Cost

If your insurance plan covers behavioral medicine or psychotherapy, your premium may cover most, if not all of your therapy. In comparison, private practices will generally charge around $200 per session.

How Much Does Art Therapy Cost?

There are various art therapy programs offered across the country -- some which cost $250. In other cases, art therapy programs are provided for free through local community organizations. For more intensive art therapy, expect to pay at least $100 per hour.

Cost of Counseling By Specialist

If you're wondering what the average cost of therapy is, it's important to understand the various factors involved -- all of which influence the final price of a therapist. To obtain private therapy, expect to pay as little as $50 for a one-hour session, up to $300+ per session in larger, metropolitan areas.

Psychiatrist Cost

Typically, a psychiatrist costs more than a psychologist, based on their medical background. Although each practice differs, you can expect to pay between $300 to $500 for your initial consultation, followed by at least $100 per hour as you move forward with your treatment plan. On average, across the country, this rate is closer to $200 per hour.

In comparison to other titles, a psychiatrist is essentially a medical doctor who is qualified to treat the psychological and physical symptoms associated with various mental health conditions. This includes treatment related to substance abuse disorders.

In most cases, a psychiatrist will work with their patient's doctor and psychologist to implement the best possible treatment strategy. Unlike psychologists, psychiatrists can treat patients with medication -- which is particularly important when treating seriously ill individuals, suffering from conditions such as schizophrenia.

Psychologist Cost

Similar to psychiatrists, psychologists typically charge anywhere from $70 to $150 per session. In select regions across the country, the standard rate is $250 per one-hour session, as recommended by the Association for Psychological Science. However, many psychologists will offer a sliding scale fee, which is based on your specific income level.

While a psychologist is not a medical doctor, they do often have a Ph.D. In most cases, psychologists will work with patients while continuing to focus on their research. Most often, psychologists will specialize in a specific area, which is what influences their ongoing research.

Although psychologists do not prescribe medication, they do offer various types of evidence-based therapy options. For example, psychotherapy is an effective strategy that helps patients overcome distressing, problematic thoughts and behaviors.

Cost of Counseling

Individual seek counseling for many reasons, focusing on social, psychological, or personal difficulties. When you speak with a general counselor, expect to spend between $50 and $80 per session. Some offices will offer individuals access to student counselors who are available for as little as $20 per hour. These low rates are most often accessible to those living in low-income households. In this case, a student counselor is typically supervised by a registered psychologist who has a minimum of five years of experience.

Cost of Psychotherapy

Seeing a psychotherapist generally costs around $100 per session, with rates increasing among those who hold higher qualifications. Depending on your location, you may gain access to an hour of talk therapy for as little as $60 -- with rates reaching as high as $300 in large cities. These fees may be covered under private health insurance plans. However, in most cases, only select mental health services are covered for a certain amount of time.

There are many types of psychotherapy models available, including cognitive-behavioral therapy, interpersonal therapy, and dialectical behavior therapy. In some cases, psychotherapy is often short-term to address select issues (i.e., 15 sessions or less), while long-term psychotherapy plans are implemented when dealing with more complex, long-standing problems.

Frequently Asked Questions

How Often Should I Go To Therapy?

It's recommended that you start with one session per week then decide on the frequency after your mental health diagnosis with your therapist. Some therapy is quick and fixes the emotional pain in no time, while more extensive treatment, such as journaling, art therapy, and group therapy, heals you over months. Much of it depends on what caused the issues in the first place and whether your treatment is focused on the past, the present, or both.

How Much Does Betterhelp Cost?

For those who cannot afford $150+ per hour to speak with a licensed professional, Betterhelp offers behavioral health services online. This is based on a membership plan, which is between $40 and $70 per week, billed monthly.

Is Therapy Expensive?

While many think that therapy is expensive, you are paying for a professional service which focuses on life-altering treatment options. Those suffering from mental health conditions require this level of support -- and for those who cannot afford help, there are various options available, including local support groups and government-funded programs.

Is There a Way to Get Free Therapy?

While therapy may not be free through your insurance plan, you could benefit from a significantly reduced rate. Other options for free or low-cost therapy include sessions with a university psychologist or student (which may aid research), an employee assistance program, online services, or community resources.

Although all of these are great options to support your mental health, if you are suffering from a diagnosable condition, it is highly recommended that you speak with a licensed, professional therapist.

What To Look For In A Therapist

The main thing to keep in mind when researching the best fit for your therapy is your goals-what would you like the end result to be once the series of therapy sessions are over? Do you want to learn and implement behavioral techniques that help conquer stress, overeating, or anger; do you want to process your path of grief in a healthy way; do you and your spouse need to learn great communication tools that you are then accountable to use?

When seeking mental health care or online therapy, you should consider:

The level of training a therapist has, as highly experienced therapists will typically charge more per session. The level of training and experience a therapist also often corresponds to their reputation -- especially those who have built a successful practice. If a therapist is in high demand, they can charge more for their time.

The geographical location of your therapist. Large cities are often associated with higher costs of living, and in turn, therapists charge more per session than those who offer their services within small cities and towns. Online therapy may be cheaper since there are no physical boundaries.

Whether or not therapy services are covered under your insurance plan.

The level of specification you require. For example, if you would like to address a highly specific condition that requires an expert in that area, you may need to pay more -- especially if you're aiming to treat a rather unusual condition that is challenging to treat effectively.

Questions To Ask A Therapist

When evaluating different therapists, here are questions to ask to help you on your journey.

1. What's your approach to helping me with my issue(s)?

2. How much experience do you have with my issue?

3. Which state licenses do you hold?

4. What has been your success rate with past clients with this issue?

5. Are you directive during a session or more of a guide?

6. What homework do you give between sessions?

7. Will you see me if I run into problems between sessions?

8. Will you always be ready to start a session on time, and if we don't, can I recoup the lost minutes at a later date?

9. What is your perspective on my issue?

10. Can we do a paid test run for two or three sessions to ensure a proper fit?

Crisis Hotlines & Text Lines

If you need immediate help, please call a crisis hotline below.

Get free estimates from trusted therapists on Thervo:
Get free estimates

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How Much Does Therapy Cost In 2020? (Per Session & Hour)

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The average cost of therapy is $60 to $120 per session, with most American's paying between $20 to $250 per hour depending on the number of sessions booked, and if it's covered by health insurance. With health insurance coverage, rates average $20 to $50 per session, or about equal to your current copay.

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"The Future of Mental Health Care: Peer-To-Peer Support and Social Media" (Academic Journal) 

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"The Future of Mental Health Care: Peer-To-Peer Support and Social Media" (Academic Journal) 

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Peer Reviewed Article

Summary:
This source is a publication by the Epidemiology and and Psychiatric Sciences journal, a peer reviewed journal published by Cambridge University that publishes research in the areas of social psychiatry and epidemiology. This particular article explored the possible risks and benefits to people with severe mental illness that formed online communities on social media sites (ex. Twitter and YouTube). Although the article cautioned that these types of interactions may lead to misinformation and confusion, it also asserted that these interactions are beneficial in alleviating social stigmas, finding hope, and providing treatment insight. The article asserts that the benefits of peer-to-peer support through social media outweigh the risks.

Application:
I used this research to decide that I will include a short summary of my mental health history on my website in order to promote a sense of belongingness among visitors to the website.

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"The Age of Onset of Anxiety Disorders: A Meta-Analysis" (Academic Journal)

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"The Age of Onset of Anxiety Disorders: A Meta-Analysis" (Academic Journal)

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Evidence of Target Audience
Peer Reviewed Article

Summary:
This source is a 2016 publication from the Canadian Journal of Psychiatry, a peer reviewed academic journal. This journal provides a space for researchers to share their findings with Canadian and international psychiatric clinicians, and vise versa. This particular publication explores the AOO (Age of Onset) for specific anxiety disorders, as well as the average AOO for any anxiety disorder. This publication reports the findings of a meta-analysis which searched electronic databases for information on AOO. Researchers found that although specific anxiety disorders may have earlier or later AOO's than the average, the average AOO for any anxiety disorder is 21 years old. Research also found that more developed countries tended to have earlier ages of onset for anxiety disorders than less developed countries, and that there is no difference in age of onset for males vs females.

Application:
I used this research to discern my target audience. From this research, I came to the conclusion that my target audience is people of both genders in developed countries between the ages of about 16-25. I want to target people at/around the Age of Onset for anxiety disorders because people who just beginning to struggle with anxiety will be the most confused on how to help themselves. I am targeting people in developed countries because they have an earlier average age of onset for anxiety and because I am from a developed country, so I will better relate to those also from developed countries.

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Rationale for the "Thing"
Credible Website

Summary:
Google Trends is a website run by Google that analyzes and graphs the most popular google searches over time and across countries.
Because my target age group is people between 16-25, (an age group likely well-versed in Google), I decided to utilize Google Trends to see how often people were searching for help with anxiety. I found that searches for anxiety have been on a steady incline since late December 2019 and that the term "anxiety" is most often searched in Ireland, the United Kingdom, the United States, and Canada. This shows that my target audience, individuals from developed countries aged 16-25, are using the internet more than other groups are in search of help with anxiety.

Application:
With this in mind, I decided to create a website designed specifically to help people aged 16-25 in developed countries cope with their (probably relatively new) anxiety disorders.
To ensure that my website will come up when my audience searches "anxiety", I have added the tags "overcoming anxiety", "ways to help anxiety","anxiety disorder", "stress relief", and "anxiety self help" to my website. These were key words suggested by my website generator, Wix website builder, which generates frequently searched keywords.

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"Practice Square Breathing This DeStress Monday with Our Helpful GIF" (Website) 

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"Practice Square Breathing This DeStress Monday with Our Helpful GIF" (Website) 

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Multimedia Source
Credible Website

Summary:
Destress Monday is part of a nonprofit called The Monday Campaigns, a nonprofit run by Columbia, Johns Hopkins and Syracuse Universities. DeStress Monday helps people to start off their week on a calm note.

Application:
I used this particular page on the Destress Monday website for a gif to help demonstrate diaphragmatic breathing. I inserted the gif on my breathing blog post and cited the page on DeStress Monday.

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Square Breathing Exercise

It's no secret that deep breathing exercises are a great way to reduce stress. Taking a few moments to concentrate and breathe deeply calms not just the mind but the body. There are several ways to practice deep breathing but it's always a good idea to try something new. This Monday, try square breathing when you need to take a moment to settle down.

Square breathing is a great way to refocus your mind if you've been having a hectic day. Multitasking and busy schedules can be demanding on your brain and leave you in a fog. It's important to take a brief break and clear your head before diving back into business as usual. You don't need a visual aid but it can give you something on which to concentrate while you learn a new way to deep breathe.

Here is the practice:

1. Inhale for a count of 4

2. Hold for a count of 4

3. Exhale for a count of 4

4. Hold for a count of 4

While breathing and counting, imagine a square. If you're using a visual aid, follow the four sides of a square. Each step is a corner of the square; as you count to four, move along one side of the square at a time. You can use anything square-shaped around you - a post-it note, a mouse pad, etc. Another way to visualize while square breathing is to imagine you're running bases in a baseball diamond in slow motion.
Inhale and run to first base... two... three... four...
Hold and run to second base... two... three... four...
To start out, we recommend using GIFs that can provide you with a point of concentration. After a few sessions of square breathing, you'll be able to visualize the square in your mind while breathing deeply.

This Monday is a great day to be square and destress!

# data[].attributes.attachment_link.description
It's no secret that deep breathing exercises are a great way to reduce stress. Taking a few moments to concentrate and breathe deeply calms not just the mind but the body. There are several ways to practice deep breathing but it's always a good idea to try something new.

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Credible Website

Summary:
This site is part of the larger site for the National Institute of Mental Health, a branch of the National Institute of Health dedicated to research and treatment for mental disorders. This page provides a background on anxiety disorders in general and goes into some depth on the common anxiety disorders.

Application:
I used this site to get a foundation for my research on anxiety disorders and to discern the most common symptoms that people suffer with. I cited this source on my website on the general informational page on anxiety disorders.

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Overview

Occasional anxiety is an expected part of life. You might feel anxious when faced with a problem at work, before taking a test, or before making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, school work, and relationships.

There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, and various phobia-related disorders.

Signs and Symptoms

Risk Factors

Treatments and Therapies

Join a Study

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Occasional anxiety is an expected part of life. You might feel anxious when faced with a problem at work, before taking a test, or before making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time.

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"The Effect of Diaphragmatic Breathing on Attention, Negative Affect, and Stress in Healthy Adults" (Academic Journal) 

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"The Effect of Diaphragmatic Breathing on Attention, Negative Affect, and Stress in Healthy Adults" (Academic Journal) 

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Peer Reviewed Article

Summary:
This source is a summary of research done at Beijing Normal University on diaphragmatic breathing. This source is part of the eighth volume of the journal "Frontiers in Psychology", a peer reviewed academic journal on the psychological sciences. The researchers found that diaphragmatic breathing is effective in increasing attention and positive affect and decreasing stress in healthy adults.

Application:
I used this research to provide background for my blog post on diaphragmatic breathing and its benefits for reducing anxiety.

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Front Psychol. 2017; 8: 874.

Xiao Ma, 1, ² Zi-Qi Yue, ³ Zhu-Qing Gong, 4, ⁵ Hong Zhang, ³ Nai-Yue Duan, ³ Yu-Tong Shi, ³ Gao-Xia Wei, 5, 6,* and You-Fa Li 2,*

Abstract

A growing number of empirical studies have revealed that diaphragmatic breathing may trigger body relaxation responses and benefit both physical and mental health. However, the specific benefits of diaphragmatic breathing on mental health remain largely unknown. The present study aimed to investigate the effect of diaphragmatic breathing on cognition, affect, and cortisol responses to stress. Forty participants were randomly assigned to either a breathing intervention group (BIG) or a control group (CG). The BIG received intensive training for 20 sessions, implemented over 8 weeks, employing a real-time feedback device, and an average respiratory rate of 4 breaths/min, while the CG did not receive this treatment. All participants completed pre- and post-tests of sustained attention and affect. Additionally, pre-test and post-test salivary cortisol concentrations were determined in both groups. The findings suggested that the BIG showed a significant decrease in negative affect after intervention, compared to baseline. In the diaphragmatic breathing condition, there was a significant interaction effect of group by time on sustained attention, whereby the BIG showed significantly increased sustained attention after training, compared to baseline. There was a significant interaction effect of group and time in the diaphragmatic breathing condition on cortisol levels, whereby the BIG had a significantly lower cortisol level after training, while the CG showed no significant change in cortisol levels. In conclusion, diaphragmatic breathing could improve sustained attention, affect, and cortisol levels. 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.

Keywords: breathing technique, mental health, real-time feedback, relaxation, sustained attention

Introduction

Breathing practice, also known as "diaphragmatic breathing" or "deep breathing," is defined as an efficient integrative body-mind training for dealing with stress and psychosomatic conditions. Diaphragmatic breathing involves contraction of the diaphragm, expansion of the belly, and deepening of inhalation and exhalation, which consequently decreases the respiration frequency and maximizes the amount of blood gases. Benefits of diaphragmatic breathing have been investigated in association with meditation and ancient eastern religions (such as Buddhism) and martial arts ( Lehrer et al., 2010). It is considered to be a core component of yoga and Tai Chi Chuan (TCC) and contributes to emotional balance and social adaptation ( Sargunaraj et al., 1996; Beauchaine, 2001; Porges, 2001), as well as special rhythmic movements and positions.

Psychological studies have revealed breathing practice to be an effective non-pharmacological intervention for emotion enhancement ( Stromberg et al., 2015), including a reduction in anxiety, depression, and stress ( Brown and Gerbarg, 2005a, b; Anju et al., 2015). A 1-day breathing exercise was found to relieve the emotional exhaustion and depersonalization induced by job burnout ( Salyers et al., 2011). A 30-session intervention with a daily duration of 5 min can significantly decrease the anxiety of pregnant women experiencing preterm labor ( Chang et al., 2009). In addition, similar effects on anxiety was observed in a 3-days intervention study, where breathing practices were performed 3 times per day ( Yu and Song, 2010). Further evidence from a randomized controlled trial (RCT) suggested that a 7-days intensive residential yoga program that included pranayama (breathing exercises) reduced anxiety and depression in patients with chronic low back pain ( Tekur et al., 2012). Supportive evidence has also come from a line of RCTs of TCC and yoga ( Benson, 1996; Telles et al., 2000; Oakley and Evans, 2014). Currently, breathing practice is widely applied in clinical treatments for mental conditions, such as post-traumatic stress disorder (PTSD) ( Sahar et al., 2001; Descilo et al., 2010; Goldin and Gross, 2010), motion disorders ( Russell et al., 2014), phobias ( Friedman and Thayer, 1998), and other stress-related emotional disorders.

Earlier studies have observed an attention/vigilance impairment related to breathing dysfunction in dementia and sleep-disordered breathing in individuals across all ages ( Chervin et al., 2006). More recent studies have suggested that there is a bidirectional association between breathing and attention. A growing number of clinical studies have demonstrated that breathing-including meditation may represent a new non-pharmacological approach for improving specific aspects of attention. Mindfulness, for instance, contributes to alerting and orienting, but conflicts with monitoring. In addition, an 8-weeks mindfulness-based stress reduction yielded a larger effect than a 1-month intensive mindfulness retreat, on the attention altering component ( Jha et al., 2007). Focused attention meditation is a Buddhist practice, whereby selective attention and the sensation of respiration must be sustained ( Gunaratana, 1993/2002; Gyatso and Jinpa, 1995). Three months of intensive focused attention meditation have been found to reduce variability in attentional processing of target tones and to enhance attentional task performance ( Lutz et al., 2009). Some studies have investigated cognitive and emotional improvement simultaneously, and have indicated that a brief mental training could enhance sustained attention as well as reduce fatigue and anxiety ( Zeidan et al., 2010). Some researchers believe that the relaxation generated by peaceful breathing helped to manage inattention symptoms among children with attention deficit-hyperactivity disorder (ADHD) ( Amon and Campbell, 2008). These results led to the development of a breath-controlled biofeedback game called ChillFish, which improved children's sustained attention and relaxation levels ( Sonne and Jensen, 2016).

Studies orientated toward the physiological mechanism of breathing intervention effects have indicated a shared physiological basis underlying breathing, emotion, and cognition, involving the autonomic nervous system. Physiological evidence has indicated that even a single breathing practice significantly reduces blood pressure, increases heart rate variability (HRV) ( Wang et al., 2010; Lehrer and Gevirtz, 2014; Wei et al., 2016) and oxygenation ( Bernardi et al., 1998), enhances pulmonary function ( Shaw et al., 2010), and improves cardiorespiratory fitness and respiratory muscle strength ( Shaw et al., 2010). A daily 15-min breathing training for 2 weeks significantly promoted mean forced expiratory volume in 1 s and peak expiratory flow rate ( Bernardi et al., 1998). Breathing with a certain frequency and amplitude was found to relieve clinical symptoms in patients of all ages with sleep-disordered breathing ( Chervin et al., 2006). Evidence from yoga practice also confirms a reduction of sympathetic and an increase of parasympathetic nervous system activity ( Vempati and Telles, 2002; Raghuraj and Telles, 2003). Cardiac vagal tone is assumed to form part of the shared physiological basis of breathing and emotion. It is influenced by breathing and is also integral to vagal nerve stimulation that is closely associated with the physiological basis of emotion, including emotional regulation, psychological adaptation ( Sargunaraj et al., 1996; Beauchaine, 2001), emotional reactivity and expression, empathic responses, and attachment ( Porges, 2001). Moreover, dysfunction of the autonomic nervous system is observed in adults with anxiety ( Kawachi et al., 1995; Thayer et al., 1996; Friedman and Thayer, 1998), depression ( Carney et al., 1995; Lehofer et al., 1997), PTSD ( Sahar et al., 2001), panic disorder ( Friedman and Thayer, 1998), and other stress-related mental and physical disorders ( Benson, 1996; Becker, 2000; Bazhenova et al., 2001; Jacobs, 2001).

The shared physiological basis of attention and breathing can be detected in part in the autonomic nervous system of patients with ADHD ( Beauchaine, 2001), but more evidence is provided by electroencephalographic (EEG) studies and functional magnetic resonance imaging (fMRI) studies ( Lutz et al., 2004). For instance, EEG studies have suggested that regular breathing practice during yoga and meditation can increase β-activity in the left frontal, midline, and occipital brain regions ( Bhatia et al., 2003; Snayder et al., 2006), which has been associated with enhanced cognitive performance, such as during attention, memory, and executive functions ( Freeman et al., 1999). In addition, fMRI studies have also detected a significant increase in activation in the bilateral inferior frontal and temporal regions under meditation, as compared to a relaxation condition. Such studies implicated the right inferior frontal cortex/right insula and right middle/superior temporal cortex as the regions involved in meditation ( Hernández et al., 2015).

Cortisol, a steroid hormone of the glucocorticoid class, is released in response to stress. Cortisol release is associated with depression, anxiety, and other negative emotions. The underlying mechanism may be grounded in its sensitivity for the activity of the hypothalamic-pituitary-adrenal (HPA) axis ( Clow et al., 2010), which regulates metabolism, immunity, and some mental processing, including memories and emotional appraisal ( Pariante and Lightman, 2008). Plasma cortisol levels reflect changes in the activation of the HPA axis with changes in CO ₂ inhalation ( Argyropoulos et al., 2002), while salivary cortisol levels have been associated with fast withdrawal of attention in response to angry faces ( van Honk et al., 1998). However, the associations between breathing, emotion, attention, and cortisol have not been tested together.

Although breathing practice offers an integrated benefit for mental and physical health, the results of studies on this topic are inconsistent, because of methodological limitations in the experimental design, a lack of measurable breathing feedback, and limited sample sizes. Most cross-sectional and longitudinal studies have focused on how breathing treatment benefits individuals with particular conditions, such as women during pregnancy ( Schmidt et al., 2000; Booth et al., 2014) and clerks experiencing job burnout ( Salyers et al., 2011), rather than on its health promotion function in a healthy population. Most importantly, most studies have investigated physiological effects, emotional benefits, and cognitive benefits separately, which prevents an understanding of the possible mental and physiological mechanisms of breathing in terms of its potential benefit for both mental and physical health.

The present study was a pilot RCT with visible feedback breathing recordings used to monitor the breathing performance overall and to evaluate the outcomes of breathing practice. The aims of this study were to investigate the mental benefits and the hormone levels in healthy volunteers who completed an 8-weeks breathing training scheme. An emotional self-reporting scale and cognitive tests were used to measure mental benefits. Additionally, cortisol a major HPA-axis-related stress hormone in humans ( Matousek et al., 2010), was also measured to examine whether the breathing practice could be a buffer for modulating stress levels in the working population. We hypothesized that an 8-weeks breathing training course would significantly improve cognitive performance, and reduce negative affect (NA) and physiological stress.

Materials and Methods

Participants

Participants were recruited from a local IT company in Beijing, China. The Institute Review Board of Beijing Normal University approved this study. This study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The procedure of the study was fully explained to the participants, and informed written consent was obtained from each participant before the study.

All participants completed the following screening forms: (1) a health approval from a recent physical check-up at a medical center and (2) a demographic questionnaire that included basic demographic information and mind-body training experience. Participants who had a history of physical health problems, such as cardiovascular or cerebrovascular diseases, respiratory diseases, autoimmune diseases, diabetes, neuropathy, and drug or alcohol abuse, were excluded from the study. In addition, participants who had yoga, TCC, or Qigong experience, as well as other mind-body training, were excluded.

Experimental Protocol

All interventions and tests were performed in a sunny, soundproof, open-air conference room at the IT company rather than in our laboratory. We reasoned that this would avoid any potential anxiety that could be brought on by rushing from the workplace to the laboratory. Participants sat comfortably in leather armchairs throughout the study.

A final total of 40 participants were included in this study. They were assigned to a breathing intervention group (BIG, 10 females and 10 males) or a control group (CG, 10 females and 10 males) by alternating the order of their registration. Gender balance was also taken into consideration during this sampling procedure.

The BIG learnt basic knowledge and essential skills about diaphragmatic breathing, and became familiar with experiencing breathing in as deeply as possible and then exhaling almost all the air from the lungs, slowly, in a self-controlled, slow rhythm, under the guide of a coach. All participants were instructed to focus on their breathing and the sensations produced in the body, while sitting comfortably in chairs with their eyes closed. Participants were considered as performing diaphragmatic breathing if their respiratory rate decreased while their respiratory amplitude increased in waveform.

After this learning phase, both groups completed the baseline tests. These included the Positive and Negative Affect Schedule (PANAS), the Number Cancellation Test (NCT), and a cortisol test. Thereafter, the BIG received 20-sessions of breath-controlling intervention. Each intervention involved a 15-min resting breathing session and a 15-min diaphragmatic breathing session consequently. The diaphragmatic breathing session began with general verbal guidance from the breathing coach, who spoke at a slow speed to help participants to become more easily involved. A final test, similar to the baseline test, was implemented at the end of the 20th intervention. In contrast, the CG received only an introduction of breathing and rest, a baseline test, and a final test, without any other intervention.

The experimental training procedure consisted of 20 sessions over a period of 8 weeks. Each session was conducted every other day on weekdays. Both groups were informed of the purpose and the procedures of this study after training. In the BIG, 20 participants were required to conduct resting breathing for 15 min and diaphragmatic breathing for 15 min in each session (). During resting breathing, participants were instructed to breathe in a normal state. With closed eyes while sitting comfortably. During diaphragmatic breathing, they were instructed to inhale as deeply as they could while their abdomen expanded, and to exhale as slowly as they could while their abdomen contracted, in a self-paced rhythm, under the instruction of a breathing training coach and with feedback via a recording device. The two breathing conditions were recorded during the entire 30-min training. Therefore, each participant's breathing waves were visible and monitored by the experimenter to ensure that participants were following the instructions completely. For the CG, data of resting breathing and diaphragmatic breathing from 20 participants were collected on the first day of training and on the last day of training. Before and after the entire training, the two groups completed the PANAS, NCT, and cortisol level test ().

Breath Recording

Synchronous breathing signals were recorded using breathing monitors (Dongtuo Science and Technology Ltd., Beijing, China) that recorded participants' respiration with a high temporal resolution. All data were collected by inductive sensors (JD/PW-5; Boda Electron Co., Beijing, China), which were kept against the chest of each participant during the rest condition, or alternatively against the abdomen during diaphragmatic breathing. Data were transferred to the host computer (Lenovo, M4600 P3.0HT 25640VN) via Bluetooth and expressed on-screen as continuous visual waveforms. The height of the wave crest represented the amplitude of a single breath, while the wavelength indicated the duration. Each computer was connected to two inductive sensors; 10 recordings were made simultaneously.

All five research assistants were postgraduate students in psychology. They attended a meeting in which training was given and breath recording was practiced for approximately 1 week prior to the formal experiment, in order to standardize the data collection procedure. Each of them monitored breathing processes for two participants concurrently and ensured that data input and output proceeded smoothly.

Throughout the breathing process, all participants kept their eyes closed and breathed through the nose. The assistants supervised their recordings and obtained the help of the coach if the recording vibrated or if the breathing frequency remained higher than 6 breaths/min by 2 min after the intervention began. The coach offered special guidance to help these participants attain diaphragmatic breathing.

Psychological Measurements

All participants were asked to complete behavioral measurements before training and after training. The behavioral measurements included the PANAS and the NCT. The PANAS ( Watson et al., 1988) is a 5-point Likert scale that measures participants' feelings during the past week. It includes 20 self-reported items that are equally divided into a positive affect (PA) subscale and a NA subscale. Items are scored on a scale of 1-5, indicating very slightly or not at all, a little, moderately, quite a bit, and very much, respectively. The PANAS scale is highly internally consistent, largely uncorrelated, stable, and reliable across cultures, and can distinctively estimate PA and NA at the same time ( Thompson, 2007).

The NCT includes one short practice sheet and four test sheets for evaluate attention sustainability, which is reflected by the scores generated according to the accuracy in the test. Each sheet contains 200 single digits with special symbols below or above them. The targets are "9" digits with two symbols below, above, or on either side. Participants were asked to cross out targets with a slash and ignore targets placed subsequent to a "5" as quickly as possible, within 1 min for each sheet. Participants had a 10- to 20-s interval break between two sheets. The final scores were yielded by the sum of the correct number of target digits for each sheet.

Neuroendocrine Test

Salivary cortisol was collected four times with the Salivette ® Cortisol (Art. No. 51.1534) (Sarstedt AG and Co., Nümbrecht, Germany) at two time points: before and after diaphragmatic breathing at baseline, and before and after the diaphragmatic breathing at the final test. All salivary cortisol samples were processed according to the manufacturer's instructions. Before collection, all participants were required to take a 5-min break. Each participant was asked to refrain from eating or drinking (except water) within 20 min before saliva collection. In both the BIG and CG, the saliva sample was collected between 11:00 and 12:00 to control for the variation in cortisol levels over the circadian rhythm.

Salivary cortisol was analyzed using a competitive enzyme immunoassay (ELISA, DiaMetra ®, Perugia, Italy), which had a 3-10 g/mL limit of cortisol, for collections before lunch, according to specifications provided by the manufacturer DiaMetra ®. An intra-assay coefficient variation (9.8%) and an inter-assay coefficient variation (15%) were calculated according to Jaedicke et al. (2012) (Validation and quality control of ELISAs for the use with human saliva samples) ( Kirschbaum and Hellhammer, 1994; Ogbureke and Ogbureke, 2015).

Results

Demographic Characteristics

Demographic characteristics of all the participants in each group are summarized in . The paired t-tests showed that there were no between-group differences in terms of age [ t(38) = 1.31; p = 0.56, Cohen's d = 0.420], years of education [ t(38) = 1.47; p = 0.56, Cohen's d = 0.465], or work experience [ t(38) = 1.05; p = 0.22, Cohen's d = 0.331]. These results indicate that the BIG and CG were well balanced in age, years of education, and work experience.

Table 1

Characteristics

BIG (n = 19)

CG (n = 20)

t

p

Respiratory Rate

Descriptive statistics showed the average respiratory rate to be 4 times/min in the diaphragmatic breathing condition ( M ± SD = 3.45 ± 1.86) and 17 times/min in the resting breathing condition ( M ± SD = 17.51 ± 5.02) ().

Table 2

Session

Resting breathing (n = 19)

Diaphragmatic breathing (n = 19)

Mean

Standard deviation

Mean

Standard deviation

A 2 × 20 within-subject repeated measures analysis was conducted to analyze the change in respiratory rate between the resting and diaphragmatic breathing conditions across all time-points, after each of the 20 sessions, in the BIG. The within-group factors were breathing conditions (diaphragmatic vs. resting) and intervention times (20 assessments). This analysis revealed a significant effect of time, F(19,133) = 2.09, p = 0.008, = 0.23, and a significant effect of breathing condition, F(1,7) = 99.60, p < 0.000, = 0.93. There was also a significant interaction between time and condition, F(19,133) = 5.28, p < 0.000, = 0.43. The simple effect revealed that there were significant frequency drops (compared to time point 1) at time point 8, MD = 2.36, p = 0.027, time point 11, MD = 1.77, p = 0.018, time point 13, MD = 2.38, p = 0.019, time point 15, MD = 2.53, p = 0.006, time point 16, MD = 2.28, p = 0.014, time point 18, MD = 1.61, p = 0.033, and time point 20, MD = 2.23, p = 0.023. The simple effects on breathing shows that the respiratory frequencies in diaphragmatic breathing were significantly below that in resting breathing at every intervention time point, with the MDs ranging from 5.63 to 15.93, all p s < 0.002. These results indicated that the breathing intervention successfully reduced the breathing frequency in the diaphragmatic breathing condition in the BIG.

A 2 × 2 mixed repeated measures analysis was conducted to analyze the change in the respiratory rate between the resting and diaphragmatic breathing conditions across time points and groups (see ). The within-group factor was the intervention session (baseline test and final line test), while the between factor was group (BIG vs. CG). The reduction of breathing frequency between diaphragmatic and resting conditions was employed as the measure. This analysis revealed a significant main effect of condition, F(1,36) = 23.36, p = 0.000, = 0.39, and an interaction between condition and groups, F(1,36) = 7.66, p = 0.009, = 0.175. A simple effect measurement was conducted and revealed that there was no significant between-group difference during resting breathing, MD = 0.43, p = 0.861, but diaphragmatic breathing frequency was significant lower than that during resting breathing, MD = 7.12, p = 0.000. The respiration frequency in diaphragmatic breathing was significantly less than that in resting breathing in the BIG, MD = 9.19, p = 0.000, but no similar result was detected in the CG, MD = 2.50, p = 0.153. These results indicated that the diaphragmatic breathing intervention was effective in both the BIG and the CG, but a significant breathing frequency decrease was only observed in the BIG.

Positive and Negative Affect

A 2 × 2 mixed repeated measures analysis was conducted to analyze the change in NA across the intervention (see ). The between-group factor was group (BIG vs. CG), while the within-group factor was test time (baseline test vs. final test). Time and group revealed a marginally significant interaction, F(1,37) = 3.43, p = 0.07, = 0.09. A simple effect measurement was conducted and revealed that the BIG demonstrated a significant reduction in NA score after the intervention, MD = 2.55, p = 0.02, while no similar results were detected in the CG, MD = -0.15, p = 0.88. There was no significant main effect of time, F(1,37) = 2.72, p = 0.11, = 0.07, or of group, F(1,37) = 0.9, p = 0.34, = 0.02.

A 2 × 2 mixed repeated measures analysis was conducted to analyze the change in PA across the intervention. We measured the between-group differences (BIG vs. CG) in PA at the baseline test and final test and detected an insignificant interaction between group and test times, F(1,37) = 0.17, p = 0.68, = 0.005, a non-significant main effect of time, F(1,37) = 0.96, p = 0.33, = 0.03, and a non-significant main effect of group, F(1,37) = 0.29, p = 0.60, = 0.008.

Sustained Attention

A 2 × 2 mixed repeated measures analysis was conducted to analyze the change in the NCT score across the intervention (see ). We measured between-group differences (BIG vs. CG) in the NCT score change at the baseline and final tests. The NCT result revealed a significant interaction between time and group, F(1,37) = 9.68, p = 0.004, = 0.21. A simple effect measurement was conducted and revealed that the BIG showed a significant increase in the NCT score after the intervention, MD = 6.728, p = 0.000), and similar results were detected in the CG, MD = 4.19, p = 0.000. The main effect of time was significant, F(1,37) = 191.48, p = 0.00, = 0.84, so was the main effect of group, F(1,37) = 0.01, p = 0.93, = 0.00.

Salivary Cortisol

A 2 × 4 mixed repeated measures analysis was conducted to analyze the change in salivary cortisol concentration across the intervention (see ). The between-group factor was group (BIG vs. CG), while the within-group factor was test time (test 1, test 2, test 3, and test 4). The salivary cortisol samples were collected before and after diaphragmatic breathing for both baseline and final tests. The concentration result revealed a significant interaction of time and group, F(3,111) = 9.06, p = 0.000, = 0.20. A simple effect measurement revealed that the BIG showed a significant decrease in salivary cortisol concentration after the intervention, whereby the concentration was significantly lower in test 3 and test 4 as compared to test 1 and test 2, MD ₁₋₃ = 1.32, p = 0.003, MD ₁₋₄ = 1.39, p = 0.002, MD 2,3 = 1.59, p = 0.00, MD ₁₋₃ = 1.66, p = 0.00. However, no similar result was found in the CG, p > 0.05. The main effect of time was significant, F(1,37) = 4.17, p = 0.008, = 0.10, but there was no significant main effect of group, F(1,37) = 0.01, p = 0.92, = 0.00.

Discussion

Using a randomized controlled design, the present study examined whether 8 weeks of intensive diaphragmatic breathing training, a core component of mind-body practices, could influence cognition, emotion, and physiological responses. As expected, the lowered frequency of respiration after the intervention suggested that the diaphragmatic breathing intervention had been inculcated. The NA score decreased after the intervention, but the PA did not change. Sustained attention scores increased after the intervention. Moreover, a significant time effect of diaphragmatic breathing on cortisol levels was observed (before training vs. after training tests), although no group differentially influence cortisol. We interpret the findings as illustrating the potential benefits of diaphragmatic breathing practice for improving cognitive function and reducing negative affect and physiological responses to stress in healthy adults.

The Effectiveness of Breathing Practice

Numerous studies in health psychology and clinical treatment have demonstrated that diaphragmatic breathing is an effective relaxation technique in complementary and alternative medicine, with beneficial effects on physical and mental health ( Cahalin et al., 2002; Tsang et al., 2015; Chen et al., 2016). However, in most studies of mind-body intervention, diaphragmatic breathing worked as a latent component or an essential preparation for the core intervention regime, such as meditation, TCC, or yoga ( Telles et al., 2000; Oakley and Evans, 2014). In the present study, we monitored the breathing as an independent mind-body intervention form to discuss the health contribution to cognition, emotion, and stress response when respiration slowed. In order to achieve this aim, we adopted a unique breathing control method, which combined a monitoring device and coach supervision simultaneously.

In previous studies, practice duration and times were key characters for depicting an intervention protocol, but these seldom reported the final breathing rate and the manner in which respiration frequency decreased. In a study of slow-breathing training on chronic heart failure ( Drozdz et al., 2016) reported its protocol as a 10-12 weeks' (15 min per day) slow-breathing training with a breathing rate at 6 breaths/min, which meets the key requirements of diaphragmatic breathing. A clear respiration frequency provides a reliable and reproducible operation standard for estimating whether the intervention successfully decreased the respiration frequency. In the present study, the significant difference in respiration rate between the diaphragmatic breathing and resting breathing conditions confirmed that participants correctly followed the protocol for diaphragmatic breathing. The non-significant between-group difference in the respiration frequency in the resting breathing condition confirmed the distinction between the two breathing conditions. In addition, the continuous decrease in respiration rate observed in the BIG represented the process of learning and practice. All these results indicate that the change in respiratory rate could be attributed to the effectiveness of the diaphragmatic breathing practice over the 8 weeks. They also indirectly implied that the positive effects in this study were induced by intensive diaphragmatic breathing practice, rather than any confounding variables.

The present study employed a breathing monitor with results visualized on a screen and with a senior yoga coach providing professional guidance and instruction. Previous studies have demonstrated that most participants could follow self-paced breathing instructions via audio or video cues. Clinical studies usually adopt a breathing device with quantitative feedback parameters, such as respiratory rate or HRV ( Sherlin et al., 2010). Respiratory sinus arrhythmia biofeedback has also been used to examine the effect of breathing practice on HRV and symptoms of PTSD, which revealed a significantly greater reduction in depressive symptoms and increases in HRV indices for individuals with respiratory sinus arrhythmia ( Zucker et al., 2009). These breathing devices with feedback parameters have an advantage over visual or auditory instructions, without feedback ( Brown et al., 2013), and have been widely applied in treatment for physical and mental disorders. Inviting a senior breathing coach is an alternative solution for breathing practice and control ( Drozdz et al., 2016). In the present study, the coach strictly guided and monitored the entire process of diaphragmatic breathing during 20 sessions in a previous study. These two methods guaranteed that the participants breathed properly under two conditions under specific supervision during training. Having an appropriate monitor was another problem that was encountered in breathing practice studies.

Breathing Practice to Decrease Negative Affect

Emotional improvements have been reported to be the most obvious benefit of mind-body interventions ( Stromberg et al., 2015). It has been suggested that the detrimental effects of stress and negative emotions could be counteracted by different forms of breathing techniques, meditation, and relaxation ( Jerath et al., 2015), as well as by yoga and TCC ( Benson, 1996; Telles et al., 2000; Oakley and Evans, 2014). A non-randomized study suggested that a 1-week breathing practice decreased the mean of Post-traumatic Checklist-17 (PCL-17), Beck Depression Inventory (BDI-21), General Health Questionnaire (GHQ-12) in survivors of the 2004 South-East Asia tsunami. Their results indicated an equivalent effect of breathing practice with a traumatic incident reduction exposure therapy. Moreover, the effects persisted for at least 24 weeks after the intervention had finished ( Descilo et al., 2010). As a non-pharmaceutical treatment, breathing control therapy is now wildly used in dealing with depression ( Tsang et al., 2006), PTSD ( Descilo et al., 2010), insomnia ( Manjunath and Telles, 2005), and other relevant mental disorders ( Brown and Gerbarg, 2005a). It is also applied as an adjuvant treatment for patients with physical disorders, including stroke ( Marshall et al., 2014) and cancer ( Hayama and Inoue, 2012). All these lines of evidence confirmed the efficacy of diaphragmatic breathing in clinical conditions, but we have shown its benefit for healthy individuals. A previous study has also reported that a better breathing technique was associated with greater reductions in anxiety ( Sherlin et al., 2010). A 6-weeks' breathing training course was long enough to cause a significant decrease in anxiety levels in healthy adults ( Chandla et al., 2013). Evidence from diaphragmatic breathing studies suggested a significant reduction in the state anxiety after an 8-weeks' intervention measured using the Beck Anxiety Inventory Assessment in adults ( Chen et al., 2016), and a decrease in self-reported feelings of state anxiety and test performance in primary school students, by a pre-test/post-test, training-versus-control experiment ( Khng, 2016). In the present study, our 20 sessions of diaphragmatic breathing practice significantly decreased the NA scores in the BIG. This is consistent with previous results and suggested a relief of basic NA in individuals' daily lives. Although we did not detect the time point at which the emotional benefit occurred, previous studies suggested that even a one-time intervention could reduce stress, disengaged coping ( Arsenio and Loria, 2014), and could provide certain curative alleviation of job burnout, as well as other emotional disorders. In that case, it remains unknown whether the reduction of NA occurs after the first intervention or after a significant reduction in respiration frequency. This could indicate that diaphragmatic breathing can provide an emotional improvement as a potential health care effect in healthy volunteers.

Breathing Practice to Enhance Sustained Attention

Sustained attention is critical for maintaining performance over a period of time. Deficits in sustained attention are major symptoms for several mental disorders ( Winterer et al., 2000). In normal healthy participants, fatigue, work burnout, and task difficulty usually lead to poor performance in sustained attention ( Aston-Jones et al., 1999). In the present study, we investigated the diaphragmatic breathing as a single intervention method for sustained attention improvement. The results suggested that 20 session's intervention provided an improvement in the NCT score. Indirect evidence supported these results, obtained from studies about breathing involving meditation ( Lutz et al., 2009) and yoga training ( Velikonja et al., 2010). In previous studies, both long-term intervention ( MacLean et al., 2010), lasting for weeks, and short-term ( Tang et al., 2007) intervention, for a few days, were effective. Consistent with previous studies, we have detected both long-term benefits after completing the intervention as a whole in the BIG and an immediate improvement in the CG. Notably, attention improvement was gained after 15 min of diaphragmatic breathing, which was markedly shorter than the 5 days' training reported in a previous study ( Tang et al., 2007).

Previous studies have hypothesized that perceptual improvements ( MacLean et al., 2010) and stress reduction ( Jensen et al., 2012) are the mechanisms by which attentional improvement is gained. Combining the increase in the NCT score and the decrease in the NA observed in the present study, we propose that relaxation gained from diaphragmatic breathing improved the attention test performance ( Amon and Campbell, 2008; Sonne and Jensen, 2016). From the point of view of neuroscience, adjusting the imbalances in the autonomic nervous system is the unique contribution provided by breathing intervention, and was directly supported by TCC research. It indicated that the HRV increased when diaphragmatic breathing was performed, which indicated an activity balance between the sympathetic and parasympathetic systems ( Wei et al., 2016). Therefore, it is reasonable to infer that diaphragmatic breathing might modulate cognitive performance by predominantly exerting its influence on the autonomic nervous system. Although the neuro-mechanism remains to be clarified, it is likely that deep breathing could link mind and body together to regulate the information processing related to attention.

Breathing Practice and Physiological Responses

Cortisol is a reliable indicator of stress ( Feder et al., 2009), because its concentration increases when having to cope with stressful events. We employed salivary cortisol as a measure of physiological response in the present study to estimate the neurophysiological benefit of diaphragmatic breathing. Its concentration decreased significantly after the 20 sessions' intervention, which was consistent with previous results from parents of children and adolescents with diabetes type 1 ( Tsiouli et al., 2014). This result was consistent with previous studies and indicated that breathing practice reduced the stress-related physiological response level in healthy volunteers.

Cortisol is also closely associated with the HPA axis ( Clow et al., 2010), which can involuntarily control metabolism, immunity, and some mental processing, including memory and emotional appraisal ( Pariante and Lightman, 2008), and can easily be affected by breathing ( Argyropoulos et al., 2002). Its association with attention ( van Honk et al., 1998), as well as breathing practice, cognitive processing, and emotional arousal is strong. It has been suggested that the sympatho-vagal stress response returns to an optimal balance at 4.5-5.5 bpm breathing in most adults ( Lehrer et al., 2010), but no direct evidence has illuminated the potential mechanism of this physiological effect.

A hypothesis provided by Jerath et al. (2015) suggested that breathing stimulates vagal activation of GABA pathways from the prefrontal cortex and insula, to inhibit amygdala over-activity ( Brown et al., 2013). A tuning function of the brain toward a parasympathetically driven mode and positive states was observed in the left insula and left orbitofrontal cortex with increasing yoga experience ( Villemure et al., 2015). Evidence from brain imaging studies has supported this hypothesis. These results suggested that long and regular breathing-involving meditation practice significantly deactivated the limbic system ( Kalyani et al., 2011) and rostral prefrontal cortex ( Tomasino and Fabbro, 2016), and increased the activation of the right dorsolateral prefrontal cortex (DLPFC) while performing an attention-focused task. Moreover, specific changes, such as an increased cortical thickness ( Wei et al., 2013), prefrontal-hippocampus functional connectivity ( Tao et al., 2016), and a decreased regional homogeneity in the DLPFC ( Wei et al., 2014), were also detected during the resting state among TCC senior practitioners. A structural change was proposed according to the autonomic nervous evidence, and was supported by an absence of age-related gray matter decline in senior yoga practitioners, as seen on structural MRI ( Villemure et al., 2015). All these results suggested that the prefrontal cortex served as the predominant commander, supervising the activity from the limbic system, and modulating the activity of the autonomic nervous system.

Limitations

In the present study, we employed healthy volunteers as our target population. In that case, we estimated the improvement in mood and cognition and the physiological response of stress, rather than clinical symptoms, such as anxiety, depression, attentional impairment, or other stress-related pathological symptoms. In comparison to a previous study, our results investigated the application of diaphragmatic breathing as a daily health care for health population. Some of the limitations of the present study should be acknowledged. First, we discussed the diaphragmatic breathing benefits from the points of view of emotion, cognition, and physiology, respectively, rather than by combining these three aspects together to obtain further mechanism-related results. Therefore, we have deduced a limited contribution to elucidating the underlying associations between cognitive progressing, affective improvement, and physiological change. Moreover, in terms of the neuroendocrine response, the cortisol levels were reduced after a 20 interventions, but no reference criteria were provided to demonstrate whether this decrease resulted in a real physiological benefit or was only statistically significant.

In future studies, it would be interesting to investigate the time-course between NA reduction and a sustained attention score increase. We expect that a time-course would elucidate the association between emotional and cognitive benefit, and allow testing of the hypothesis that the relaxation induced by diaphragmatic breathing relieves stress and thereby benefits cognitive possessing.

Conclusion

The present study illustrates the potential for diaphragmatic breathing practice to improve cognitive performance and reduce negative subjective and physiological consequences of stress in healthy adults. Despite the promise of diaphragmatic breathing practice in supporting function and health, further investigation is needed to delineate mechanisms that underlie these benefits.

Ethics Statement

The effect of diaphragmatic breathing exercise on attention, negative affect and stress level: a preliminary randomly controlled study on occupational population was approved by the ethical broad of school of psychology, Beijing Normal University. The method, experiment design, and safety of participants were strictly approved by the ethical broad of school of psychology, Beijing Normal University.

Author Contributions

G-XW and Y-FL designed the work, drafted and finalized the manuscript. XM, Z-QY, HZ, N-YD, Y-TS, and Z-QG collected and analyzed the data, and revised the manuscript.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

We thank Mr. Ying Lu for his technical help in providing support on the devices used and for recruiting participants, and Miss Xiangshu Cui for data collection.

Footnotes

Funding. This work was supported by grants from the MOE (Ministry of Education in China) Project of Humanities and Social Sciences (No.16YJC890012) and the National Natural Science Foundation of China (31671163).

References

Amon K., Campbell A. (2008). Biofeedback video games to teach ADHD children relaxation skills to help manage symptoms. [Patoss Bull. 34-38. Available at:http://www2.fhs.usyd.edu.au/arow/biofeedback4adhd/Amon_Campbell_2008.pdf (accessed January 21, 2011). Google Scholar]

Becker I. (2000). Uses of yoga in psychiatry and medicine. [Complement. Altern. Med. Psychiatry 19 107-145.Google Scholar]

Benson T. (1996). [Timeless Healing: The Power and Biology of Belief. New York, NY: Scribner.Google Scholar]

Booth S., Burkin J., Moffat C., Spathis A. (2014). [Breathing Techniques for Breathlessness Managing Breathlessness in Clinical Practice. Berlin: Springer; 67-112. 10.1007/978-1-4471-4754-1_5 [CrossRef] Google Scholar]

Chen Y. F., Huang X. Y., Chien C. H., Cheng J. F. (2016). The effectiveness of diaphragmatic breathing relaxation training for reducing anxiety. [Perspect. Psychiatr. Care 10.1111/ppc.12184 [Epub ahead of print]. [PubMed] [CrossRef] Google Scholar]

Gunaratana H. (1993/2002). [Mindfulness in Plain English. Boston, MA: Wisdom.Google Scholar]

Gyatso T., Jinpa G. T. (1995). [The World of Tibetan Buddhism: An Overview of Its Philosophy and Practice. Somerville, MA: Wisdom Publications.Google Scholar]

Khng K. H. (2016). A better state-of-mind: deep breathing reduces state anxiety and enhances test performance through regulating test cognitions in children. [Cogn. Emot. 10.1080/02699931.2016.1233095 [Epub ahead of print]. [PubMed] [CrossRef] Google Scholar]

Ogbureke K. U., Ogbureke E. I. (2015). "The history of salivary diagnostics," in [Advances in Salivary Diagnostics ed. Streckfus C. F. (Berlin: Springer; ) 17-31.Google Scholar]

Snayder N. A., Agarkova N. O., Lyulyakina E. G. (2006). "The bioelectrical brain activity in humans who practiced Sudarshan Kriya," in [Proceedings of the World Conference Expanding Paradigms: Science, Consciousness and Spirituality New Delhi.Google Scholar]

Sonne T., Jensen M. M. (2016). "ChillFish: a respiration game for children with ADHD," in [Proceedings of the TEI'16: Tenth International Conference on Tangible, Embedded, and Embodied Interaction Eindhoven: 10.1145/2839462.2839480 [CrossRef] Google Scholar]

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The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults

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A growing number of empirical studies have revealed that diaphragmatic breathing may trigger body relaxation responses and benefit both physical and mental health. However, the specific benefits of diaphragmatic breathing on mental health remain largely ...