Enter your details:
Name:
E-mail:
 
Thank you for subscribing.
Subscribe to our newsletter!


Alessandro Nota1, Goran Kuvacic2, Maha Sellami3, Andrea De Giorgio4

1Vita-Salute San Raffaele University and IRCCS San Raffele Scientific Institute, Milan, Italy
2University of Split, Faculty of Kinesiology, Split, Croatia
3Qatar University, College of Education, Physical Education department, Doha, Qatar
4eCampus University, Department of Psychology, Novedrate, Italy

Reviewing the Relationship between Physiology of Breathing and Physical Activity in Anxiety Disorders

Sport Mont 2021, 19(3), Ahead of Print | DOI: 10.26773/smj.211013

Abstract

The possible influence of the quality of breathing on physical activity remains the subject of numerous scien- tific studies in different fields, including not only the most basic physiological and biological concepts but also the fields of psychiatry, psychology, and neuroscience. The literature about the relationship between breathing and psychophysiological factors is continuously growing, and several studies have investigated the influence of breathing techniques on human beings. This review aims to give a literature overview of the respiratory function impact on psychopathology, taking into account anxiety disorders, physical activity, and the relationship be- tween them. Literature investigating different topics involving the influence of breathing on anxiety disorders, the influence of breathing on physical activity and related anxiety disorders showed an association between them even if this relationship is not well clarified. Regular physical activity could become even a primary or pref- erential treatment. Relaxation techniques, as well as motor visualization, mindfulness, and even oral appliances, could help people improve their general condition with the improvement of the control of their psychophysical performance. Further literature with different physical activities and experiences regarding psychodynamic treat- ments could assume a new scenario.

Keywords

mindfulness, relaxation techniques, panic disorder, psychopathology



View full article
(PDF – 271KB)

References

Allen, B., & Friedman, B. H. (2012). Positive emotion reduces dyspnea during slow paced breathing. Psychophysiology, 49(5), 690–696. https://doi.org/10.1111/j.1469-8986.2011.01344.x

Alsubaie, M., Abbott, R., Dunn, B., Dickens, C., Keil, T. F., Henley, W., & Kuyken, W. (2017). Mechanisms of action in mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) in people with physical and/or psychological conditions: A systematic review. Clinical Psychology Review, 55, 74–91. https://doi.org/10.1016/j.cpr.2017.04.008

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM–5).

Arch, J. J., & Craske, M. G. (2006). Mechanisms of mindfulness: emotion regulation following a focused breathing induction. Behaviour Research and Therapy, 44(12), 1849–1858. https://doi.org/10.1016/j.brat.2005.12.007

Aylett, E., Small, N., & Bower, P. (2018). Exercise in the treatment of clinical anxiety in general practice - a systematic review and meta-analysis. BMC Health Services Research, 18(1), 559. https://doi.org/10.1186/s12913-018-3313-5

Bachrach, A., & Egstrom, G. (1987). Stress and Performance in Diving. (Best Publishing Co., Ed.). San Pedro (CA, USA).

Bär, K.-J., & Markser, V. Z. (2013). Sport specificity of mental disorders: the issue of sport psychiatry. European Archives of Psychiatry and Clinical Neuroscience, 263 Suppl, S205-10. https://doi.org/10.1007/s00406-013-0458-4

Baron, D., Reardon, C., & Baron, S. (2013). Clinical Sports Psychiatry. An International Perspective. (Wiley-Blackwell, Ed.). Oxford.

Bordoni, B., Purgol, S., Bizzarri, A., Modica, M., & Morabito, B. (2018). The Influence of Breathing on the Central Nervous System. Cureus, 10(6), e2724. https://doi.org/10.7759/cureus.2724

Breedvelt, J. J. F., Amanvermez, Y., Harrer, M., Karyotaki, E., Gilbody, S., Bockting, C. L. H., … Ebert, D. D. (2019). The Effects of Meditation, Yoga, and Mindfulness on Depression, Anxiety, and Stress in Tertiary Education Students: A Meta-Analysis. Frontiers in Psychiatry, 10, 193. https://doi.org/10.3389/fpsyt.2019.00193

Byrne, A., & Byrne, D. G. (1993). The effect of exercise on depression, anxiety and other mood states: a review. Journal of Psychosomatic Research, 37(6), 565–574.

Carter, K. S., & Carter, R. (2016). Breath-based meditation: A mechanism to restore the physiological and cognitive reserves for optimal human performance. World Journal of Clinical Cases, 4(4), 99–102. https://doi.org/10.12998/wjcc.v4.i4.99

Chambers, D. C., Carpenter, D. A., & Ayres, J. G. (2001). Exchange dynamics of nitric oxide in the human nose. Journal of Applied Physiology (Bethesda, Md. : 1985), 91(5), 1924–1930. https://doi.org/10.1152/jappl.2001.91.5.1924

Chekroud, S. R., Gueorguieva, R., Zheutlin, A. B., Paulus, M., Krumholz, H. M., Krystal, J. H., & Chekroud, A. M. (2018). Association between physical exercise and mental health in 1·2 million individuals in the USA between 2011 and 2015: a cross-sectional study. The Lancet. Psychiatry, 5(9), 739–746. https://doi.org/10.1016/S2215-0366(18)30227-X

Cheng, R. W. F., Borrett, D. S., Cheng, W., Kwan, H. C., & Cheng, R. S. S. (2010). Human prefrontal cortical response to the meditative state: a spectroscopy study. The International Journal of Neuroscience, 120(7), 483–488. https://doi.org/10.3109/00207454.2010.483650

Clark, D. M., Salkovskis, P. M., & Chalkley, A. J. (1985). Respiratory control as a treatment for panic attacks. Journal of Behavior Therapy and Experimental Psychiatry, 16(1), 23–30.

Conroy, D., & Hagger, M. S. (2018). Imagery interventions in health behavior: A meta-analysis. Health Psychology : Official Journal of the Division of Health Psychology, American Psychological Association, 37(7), 668–679. https://doi.org/10.1037/hea0000625

Csikszentmihalyi. (1977). Beyond boredom and anxiety (Book). (Jossey-Bass, Ed.), Journal of Individual Psychology (00221805) (Vol. 33). San Francisco (CA, USA). https://doi.org/10.2307/2065805

Currie, A., & Owen, B. (2016). Sport Psychiatry. (Oxford University Press, Ed.). Oxford.

De Giorgio, A. (2016). From emotional education to collaborative intelligence. Espressivamente.

De Giorgio, A, Padulo, J., & Kuvačić, G. (2018). Effectiveness of yoga combined with back school program on anxiety, kinesiophobia and pain in people with non-specific chronic low back pain: a prospective randomized trial. Muscle, Ligaments and Tendons Journal, Vol. 8(No. 1), 104–112. https://doi.org/10.11138/MLTJ/2018.8.1.104

De Giorgio, A., Dante, A., Cavioni, V., Padovan, A. M., Rigonat, D., Iseppi, F., … Gulotta, F. (2017). The IARA model as an integrative approach to promote autonomy in COPD patients through improvement of self-efficacy beliefs and illness perception: A mixed-method pilot study. Frontiers in Psychology, 8(OCT). https://doi.org/10.3389/fpsyg.2017.01682

De Giorgio, A., Kuvačić, G., Milić, M., & Padulo, J. (2018). The Brain and Movement: How Physical Activity Affects the Brain. Montenegrin Journal of Sports Science and Medicine, 7(2). https://doi.org/10.26773/mjssm.180910

De Giorgio, A., Loscalzo, R. M., Ponte, M., Padovan, A. M., Graceffa, G., & Gulotta, F. (2017). An innovative mindfulness and educational care approach in an adult patient affected by gastroesophageal reflux: the IARA model. Journal of Complementary and Integrative Medicine, 14(4). https://doi.org/10.1515/jcim-2016-0154

Dong, M., Xia, L., Lu, M., Li, C., Xu, K., & Zhang, L. (2019). A failed top-down control from the prefrontal cortex to the amygdala in generalized anxiety disorder: Evidence from resting-state fMRI with Granger causality analysis. Neuroscience Letters, 707, 134314. https://doi.org/10.1016/j.neulet.2019.134314

Dratcu, L. (2000). Panic, hyperventilation and perpetuation of anxiety. Progress in Neuro-Psychopharmacology and Biological Psychiatry. Prog Neuropsychopharmacol Biol Psychiatry. https://doi.org/10.1016/S0278-5846(00)00130-5

Durazzo, M., Gargiulo, G., & Pellicano, R. (2018). Non-cardiac chest pain: a 2018 update.Minerva Cardioangiologica, 66(6). https://doi.org/10.23736/S0026-4725.18.04681-9

Epling, W., & Pierce, W. (1996). An Overview of Activity Anorexia. In L. E. A. Publishers (Ed.), Activity Anorexia Theory, Research, and Treatment.

Farver-Vestergaard, I., O’Toole, M. S., O’Connor, M., Løkke, A., Bendstrup, E., Basdeo, S. A., … Zachariae, R. (2018). Mindfulness-based cognitive therapy in COPD: a cluster randomised controlled trial. European Respiratory Journal, 51(2), 1702082. https://doi.org/10.1183/13993003.02082-2017

Ford, J. L., Ildefonso, K., Jones, M. L., & Arvinen-Barrow, M. (2017). Sport-related anxiety: current insights. Open Access Journal of Sports Medicine, 8, 205–212. https://doi.org/10.2147/OAJSM.S125845

Freire, R. C., Lopes, F. L., Valença, A. M., Nascimento, I., Veras, A. B., Mezzasalma, M. A., … Nardi, A. E. (2008). Panic disorder respiratory subtype: A comparison between responses to hyperventilation and CO2 challenge tests. Psychiatry Research, 157(1–3), 307–310. https://doi.org/10.1016/j.psychres.2007.07.015

Freire, R. C., Perna, G., & Nardi, A. E. (2010). Panic Disorder Respiratory Subtype: Psychopathology, Laboratory Challenge Tests, and Response to Treatment. Harvard Review of Psychiatry, 18(4), 220–229. https://doi.org/10.3109/10673229.2010.493744

Gardner, F., & Moore, Z. (2007). The Psychology of Enhancing Human Performance: The Mindfulness–Acceptance–Commitment (MAC) Approach. (Springer, Ed.). New York (USA).

Garvin, A. W., Trine, M. R., & Morgan, W. P. (2001). Affective and metabolic responses to hypnosis, autogenic relaxation, and quiet rest in the supine and seated positions. The International Journal of Clinical and Experimental Hypnosis, 49(1), 5–18. https://doi.org/10.1080/00207140108410375

Goodger, K., & Broadhead, S. (2016). Managing the Anxiety of Performance. In Sport Psychiatry (pp. 17–29). Oxford: Oxford University Press.

Gorman, J. M., Kent, J. M., Sullivan, G. M., & Coplan, J. D. (2000). Neuroanatomical hypothesis of panic disorder, revised. The American Journal of Psychiatry, 157(4), 493–505. https://doi.org/10.1176/appi.ajp.157.4.493

Gorman, J. M., Papp, L. A., Coplan, J. D., Martinez, J. M., Lennon, S., Goetz, R. R., … Klein, D. F. (1994). Anxiogenic effects of CO2 and hyperventilation in patients with panic disorder. The American Journal of Psychiatry, 151(4), 547–553. https://doi.org/10.1176/ajp.151.4.547

Grazzi, L., Sansone, E., Raggi, A., D’Amico, D., De Giorgio, A., Leonardi, M., … Andrasik, F. (2017). Mindfulness and pharmacological prophylaxis after withdrawal from medication overuse in patients with Chronic Migraine: an effectiveness trial with a one-year follow-up. The Journal of Headache and Pain, 18(1), 15. https://doi.org/10.1186/s10194-017-0728-z

Griez, E., & Perna, G. (2003). Respiration and Anxiety. In Anxiety Disorders. Wiley-Blackwell Publishing.

Griffiths, T., Steel, D., Vaccaro, P., & Karpman, M. (1981). The Effects of Relaxation Techniques on Anxiety and Underwater Performance. International Journal of Sport Psychology, 12, 176–182.

Gulotta, F., Grazzi, L., Allais, G. B., Rolando, S., Saracco, M. G., Cavallini, M., … Aguggia, M. (2015). P031. An observational study on chronic tension-type headache treatment with Quantum Molecular Resonance according to I.A.R.A. model®. The Journal of Headache and Pain, 16(S1). https://doi.org/10.1186/1129-2377-16-s1-a176

Heidary, A., Emami, A., Eskandaripour, S., Saiah, A., Hamidi, S., & Shahbazi, M. (2011). Effects of Aerobic Exercise on Anxiety. Procedia - Social and Behavioral Sciences, 30, 2497–2498.

Hockley, A., Berger, J. I., Smith, P. A., Palmer, A. R., & Wallace, M. N. (2020). Nitric oxide regulates the firing rate of neuronal subtypes in the guinea pig ventral cochlear nucleus. European Journal of Neuroscience, 51(4), 963–983. https://doi.org/10.1111/ejn.14572

Hoffman, M. D., & Krouse, R. (2018). Ultra-obligatory running among ultramarathon runners. Research in Sports Medicine, 26(2), 211–221. https://doi.org/10.1080/15438627.2018.1431533

Hofmann, S. G., & Gómez, A. F. (2017). Mindfulness-Based Interventions for Anxiety and Depression. Psychiatric Clinics of North America, 40(4), 739–749. https://doi.org/10.1016/j.psc.2017.08.008

Holmes, P., & Calmels, C. (2008). A Neuroscientific Review of Imagery and Observation Use in Sport. Journal of Motor Behavior, 40(5), 433–445. https://doi.org/10.3200/JMBR.40.5.433-445

Johnson, R. (1995). Exercise dependence: when runners don’t know when to quit. Sports Medicine and Arthroscopy Review, 3(4), 267–273.

Jones, G. (1995). More than just a game: research developments and issues in competitive anxiety in sport. British Journal of Psychology (London, England : 1953), 86 ( Pt 4), 449–478.

Kuvačić, G., Fratini, P., Padulo, J., Antonio, D. I., & De Giorgio, A. (2018). Effectiveness of yoga and educational intervention on disability, anxiety, depression, and pain in people with CLBP: A randomized controlled trial. Complementary Therapies in Clinical Practice, 31, 262–267. https://doi.org/10.1016/j.ctcp.2018.03.008

Lomax, M., Tasker, L., & Bostanci, O. (2015). An electromyographic evaluation of dual role breathing and upper body muscles in response to front crawl swimming. Scandinavian Journal of Medicine & Science in Sports, 25(5), e472–e478. https://doi.org/10.1111/sms.12354

Ludwig, D. S., & Kabat-Zinn, J. (2008). Mindfulness in medicine. JAMA, 300(11), 1350–1352. https://doi.org/10.1001/jama.300.11.1350

Lum, L. (1976). The Syndrome of Habitual Chronic Hyperventilarion. In O.W. Hill (Ed.), Modern Trends in Psychosomatic Medicine (3rd ed.). London: Butterworths.

Martens, R. (1977). Sport Comopetition Anxiety Test. (Human Kinetics, Ed.). Champaign (IL, USA).

Meuret, A. E., & Ritz, T. (2010). Hyperventilation in panic disorder and asthma: Empirical evidence and clinical strategies. International Journal of Psychophysiology, 78(1), 68–79. https://doi.org/10.1016/j.ijpsycho.2010.05.006

Moran, A., Guillot, A., MacIntyre, T., & Collet, C. (2012). Re-imagining motor imagery: Building bridges between cognitive neuroscience and sport psychology. British Journal of Psychology, 103(2), 224–247. https://doi.org/10.1111/j.2044-8295.2011.02068.x

Morgan, W. P. (1995). Anxiety and panic in recreational scuba divers. Sports Medicine (Auckland, N.Z.), 20(6), 398–421. https://doi.org/10.2165/00007256-199520060-00005

Morgan, W. P., Raglin, J. S., & O’Connor, P. J. (2004). Trait anxiety predicts panic behavior in beginning scuba students. International Journal of Sports Medicine, 25(4), 314–322. https://doi.org/10.1055/s-2004-815829

Muotri, R. W., & Bernik, M. A. (2014). Panic disorder and exercise avoidance. Revista Brasileira de Psiquiatria (Sao Paulo, Brazil : 1999), 36(1), 68–75. https://doi.org/10.1590/1516-4446-2012-1012

Muzik, O., Reilly, K. T., & Diwadkar, V. A. (2018). “Brain over body”-A study on the willful regulation of autonomic function during cold exposure. NeuroImage, 172, 632–641. https://doi.org/10.1016/j.neuroimage.2018.01.067

Nardi, A. E, Valença, A. M., Lopes, F. L., Nascimento, I., Mezzasalma, M. A., & Zin, W. A. (2004). Clinical features of panic patients sensitive to hyperventilation or breath-holding methods for inducing panic attacks. Brazilian Journal of Medical and Biological Research = Revista Brasileira de Pesquisas Medicas e Biologicas, 37(2), 251–257.

Nardi, A. E, Valença, A. M., Nascimento, I., & Zin, W. A. (2001). Hyperventilation challenge test in panic disorder and depression with panic attacks. Psychiatry Research, 105(1–2), 57–65.

Nardi, A. E, Freire, R. C., & Zin, W. A. (2009). Panic disorder and control of breathing. Respiratory Physiology & Neurobiology, 167(1), 133–143. https://doi.org/10.1016/j.resp.2008.07.011

Nardi, A. E, Valença, A. M., Lopes, F. L., De-Melo-Neto, V. L., Freire, R. C., Veras, A. B., … Zin, W. A. (2007). Caffeine and 35% carbon dioxide challenge tests in panic disorder. Human Psychopharmacology, 22(4), 231–240. https://doi.org/10.1002/hup.840

Nardi, A. E, Valença, A. M., Mezzasalma, M. A., Lopes, F. L., Nascimento, I., Veras, A. B., … Zin, W. A. (2006). 35% Carbon dioxide and breath-holding challenge tests in panic disorder: a comparison with spontaneous panic attacks. Depression and Anxiety, 23(4), 236–244. https://doi.org/10.1002/da.20165

Padovan, A. M., Kuvačić, G., Gulotta, F., Sellami, M., Bruno, C., Isoardi, M., & De Giorgio, A. (2018). A new integrative approach to increase quality of life by reducing pain and fear of movement in patients undergoing total hip arthroplasty: the IARA model. Psychology, Health & Medicine, 23(10), 1223–1230. https://doi.org/10.1080/13548506.2018.1488080

Padovan, A., Oprandi, G., Padulo, J., Bruno, C., Isoardi, M., Gulotta, F., … De Giorgio, A. (2018). A novel integrative approach to improve the quality of life by reducing pain and kinesiophobia in patients undergoing TKA: the IARA Model. Muscles, Ligaments and Tendons Journal, 8, 93–103.

Paluska, S. A., & Schwenk, T. L. (2000). Physical activity and mental health: current concepts. Sports Medicine (Auckland, N.Z.), 29(3), 167–180. https://doi.org/10.2165/00007256-200029030-00003

Perna, G, Bertani, A., Politi, E., Colombo, G., & Bellodi, L. (1997). Asthma and panic attacks. Biological Psychiatry, 42(7), 625–630. https://doi.org/10.1016/S0006-3223(96)00436-2

Perna, G., Caldirola, D., & Bellodi, L. (2004). Panic disorder: from respiration to the homeostatic brain. Acta Neuropsychiatrica, 16(2), 57–67. https://doi.org/10.1111/j.0924-2708.2004.0080.x

Preter, M., & Klein, D. F. (2008). Panic, suffocation false alarms, separation anxiety and endogenous opioids. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 32(3), 603–612. https://doi.org/10.1016/j.pnpbp.2007.07.029

Reardon, C. L. (2017). Psychiatric Comorbidities in Sports. Neurologic Clinics, 35(3), 537–546. https://doi.org/10.1016/j.ncl.2017.03.007

Reese, S., Pittsinger, R., & Yang, J. (2012). Effectiveness of Psychological Intervention Following Sport Injury. Journal of Sport and Health Science, 1, 71–79.

Silva III, J. (1990). An analysis of the Training Stress Syndrome in Competitive Athletics. Journal of Applied Sport Psychology, 2(1), 5–20.

Smith, R., Smoll, F., Cumming, S., & Grossbard, J. (2006). Measurement of Multidimensional Sport Performance Anxiety in Children and Adults: The Sport Anxiety Scale. Journal of Sport and Exercise Psychology, 28, 479–501.

Smith, R., Smoll, F., & Schutz, R. (1990). Measurement and Correlates of Sport-Specific Cognitive and Somatic Trait Anxiety: The Sport Anxiety Scale. Anxiety Research, 2, 263–280.

Song, H.-M., Kim, J.-H., Heo, J.-Y., & Yu, B.-H. (2014). Clinical Characteristics of the Respiratory Subtype in Panic Disorder Patients. Psychiatry Investigation, 11(4), 412. https://doi.org/10.4306/pi.2014.11.4.412

Starosta, W. (2013). Importance of relationship between movement rhythm and respiration in physical education and in top-level sport. Polish Journal of Sport and Tourism, 20(3), 167–174. https://doi.org/10.2478/pjst-2013-0015

Stiene, H. A. (1992). Chest pain and shortness of breath in a collegiate basketball player: case report and literature review. Medicine and Science in Sports and Exercise, 24(5), 504–509.

Stillman, C. M., Cohen, J., Lehman, M. E., & Erickson, K. I. (2016). Mediators of Physical Activity on Neurocognitive Function: A Review at Multiple Levels of Analysis. Frontiers in Human Neuroscience, 10. https://doi.org/10.3389/fnhum.2016.00626

Ströhle, A., Graetz, B., Scheel, M., Wittmann, A., Feller, C., Heinz, A., & Dimeo, F. (2009). The acute antipanic and anxiolytic activity of aerobic exercise in patients with panic disorder and healthy control subjects. Journal of Psychiatric Research, 43(12), 1013–1017. https://doi.org/10.1016/j.jpsychires.2009.02.004

Swann, C., Crust, L., & Vella, S. A. (2017). New directions in the psychology of optimal performance in sport: flow and clutch states. Current Opinion in Psychology, 16, 48–53. https://doi.org/10.1016/j.copsyc.2017.03.032

Szabadi, E. (1988). Physical exercise and mental health. British Medical Journal (Clinical Research Ed.), 296(6623), 659–660.

Telles, S., Kala, N., Gupta, R. K., Verma, S., Vishwakarma, B., Agnihotri, S., … Balkrishna, A. (2019). Effect of yoga on vigilance, self rated sleep and state anxiety in Border Security Force personnel in India. Work (Reading, Mass.), 63(2), 243–251. https://doi.org/10.3233/WOR-192925

Wang, S., Sun, X., Hsia, T.-C., Lin, X., & Li, M. (2017). The effects of body mass index on spirometry tests among adults in Xi’an, China. Medicine, 96(15), e6596. https://doi.org/10.1097/MD.0000000000006596

Wang, Y., & Morgan, W. P. (1992). The effect of imagery perspectives on the psychophysiological responses to imagined exercise. Behavioural Brain Research, 52(2), 167–174.

Wemmie, J. A. (2011). Neurobiology of panic and Ph chemosensation in the brain. Dialogues in Clinical Neuroscience, 13(4), 475–483. https://doi.org/10.31887/dcns.2011.13.4/jwemmie

Wollburg, E., Roth, W. T., & Kim, S. (2011). Effects of Breathing Training on Voluntary Hypo- and Hyperventilation in Patients with Panic Disorder and Episodic Anxiety. Applied Psychophysiology and Biofeedback, 36(2), 81–91. https://doi.org/10.1007/s10484-011-9150-5

Yackle, K., Schwarz, L. A., Kam, K., Sorokin, J. M., Huguenard, J. R., Feldman, J. L., … Krasnow, M. A. (2017). Breathing control center neurons that promote arousal in mice. Science, 355(6332), 1411–1415. https://doi.org/10.1126/science.aai7984

Yates, A., Leehey, K., & Shisslak, C. M. (1983). Running — An Analogue of Anorexia? New England Journal of Medicine, 308(5), 251–255. https://doi.org/10.1056/NEJM198302033080504

Young, J. D.-E., & Taylor, E. (1998). Meditation as a Voluntary Hypometabolic State of Biological Estivation. News in Physiological Sciences : An International Journal of Physiology Produced Jointly by the International Union of Physiological Sciences and the American Physiological Society, 13, 149–153.

Young, K. S., van der Velden, A. M., Craske, M. G., Pallesen, K. J., Fjorback, L., Roepstorff, A., & Parsons, C. E. (2018). The impact of mindfulness-based interventions on brain activity: A systematic review of functional magnetic resonance imaging studies. Neuroscience & Biobehavioral Reviews, 84, 424–433. https://doi.org/10.1016/j.neubiorev.2017.08.003

Zaccaro, A., Piarulli, A., Laurino, M., Garbella, E., Menicucci, D., Neri, B., & Gemignani, A. (2018). How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing. Frontiers in Human Neuroscience, 12. https://doi.org/10.3389/fnhum.2018.00353

Zeng, R., Chen, M., & Zhang, M. (2018). Is Acupressure Useful for Alleviating Hyperventilation Syndrome? Chinese Journal of Integrative Medicine. https://doi.org/10.1007/s11655-018-2994-2

Zhang, D., Zheng, L., Wang, Q., Lu, L., & Ma, J. (2015). Displacements prediction from 3D finite element model of maxillary protraction with and without rapid maxillary expansion in a patient with unilateral cleft palate and alveolus. Biomedical Engineering Online, 14, 80. https://doi.org/10.1186/s12938-015-0074-9

Zhang, J.-Y., Cui, Y.-X., Zhou, Y.-Q., & Li, Y.-L. (2019). Effects of mindfulness-based stress reduction on prenatal stress, anxiety and depression. Psychology, Health & Medicine, 24(1), 51–58. https://doi.org/10.1080/13548506.2018.1468028

Zhang, M.-F., Wen, Y.-S., Liu, W.-Y., Peng, L.-F., Wu, X.-D., & Liu, Q.-W. (2015). Effectiveness of Mindfulness-based Therapy for Reducing Anxiety and Depression in Patients With Cancer. Medicine, 94(45), e0897-0. https://doi.org/10.1097/MD.0000000000000897

Zoccali, R., Bruno, A., Muscatello, M. R. A., La Torre, D., Paterniti, A., Corica, F., … Meduri, M. (2004). Panic-agoraphobic spectrum in obese binge eaters. Eating and Weight Disorders : EWD, 9(4), 264–268.