Resonance-Paced Breathing Alters Neural Response to Visual Cues: Proof-of-Concept for a Neuroscience-Informed Adjunct to Addiction Treatments

Abstract

Conscious attempts to regulate alcohol and drug use are often undermined by automatic attention and arousal processes that are activated in the context of salient cues. Response to these cues involves body and brain signals that are linked via dynamic feedback loops, yet no studies have targeted the cardiovascular system as a potential conduit to alter automatic neural processes that maintain cue salience. This proof-of-concept study examined within-person changes in neural response to parallel but unique sets of visual alcohol-related cues at two points in time: prior to versus following a brief behavioral intervention. The active intervention was resonance breathing, a rhythmical breathing task paced at 0.1 Hz (6 breaths per minute) that helps normalize neurocardiac feedback. The control intervention was a low-demand cognitive task. Functional magnetic resonance imaging (fMRI) was used to assess changes in brain response to the cues presented before (A1) and after (A2) the intervention in 41 emerging adult men and women with varying drinking behaviors. The resonance breathing group exhibited significantly less activation to A2 cues compared with A1 cues in left inferior and superior lateral occipital cortices, right inferior lateral occipital cortex, bilateral occipital pole, and temporal occipital fusiform cortices. This group also showed significantly greater activation to A2 cues compared with A1 cues in medial prefrontal, anterior and posterior cingulate, and precuneus cortices, paracingulate, and lingual gyri. The control group showed no significant changes. Thus, following resonance breathing, activation in brain regions involved in visual processing of cues was reduced, while activation in brain areas implicated in behavioral control, internally directed cognition, and brain-body integration was increased. These findings provide preliminary evidence that manipulation of the cardiovascular system with resonance breathing alters neural activation in a manner theoretically consistent with a dampening of automatic sensory input and strengthening of higher-level cognitive processing.

Keywords: alcohol; biofeedback; cardiovascular; functional magnetic resonance imaging; heart rate variability; neural reactivity; resonance breathing; respiration.

Figure 1

Schematic overview of the neurocardiac feedback loop. Efferent information (blue arrows) emanates from cortical, subcortical, and brain stem structures of the central-autonomic network and flows to the sinoatrial (SA) node of the heart via the sympathetic and parasympathetic branches of the autonomic nervous system. Afferent information (red arrows) from the heart and blood vessels is conveyed back to the brain via baroreceptors located mainly in the walls of the aortic and carotid arteries. Afferent signals enter the brain (shaded in green) via the nucleus tractus solitarius in the brain stem and are integrated with other sensory, cognitive, and affective information as it ascends to cortical regions, including the medial frontal, cingulate, and insular cortices.

Figure 2

Physiological data from one representative individual collected during a 5-min baseline task (normal breathing) and a 5-min resonance breathing task. Resonance breathing elicited instantaneous changes in respiration, heart rate, pulse transit time (i.e., vascular tone), systolic arterial pressure, and baroreflex sensitivity such that oscillations were magnified and more rhythmic across all measures. In addition, resonance breathing decreased systolic pressure, improved vascular tone, and increased the sensitivity of the neurocardiac feedback loop (i.e., baroreflex). Adapted from (12). Used with permission.

Figure 3

Visual depiction of the study and cue task design. Panel (A) shows the complete study design. Participants first viewed a set of nature picture cues (data not shown). Participants then viewed a set of alcohol picture cues (A1), followed by a 5-min intervention task (active condition: resonance breathing; control condition: vanilla task). They then immediately viewed a second, distinct set of alcohol picture cues (A2). The study ended with a 6-min resting state task (data not shown). Panel (B) shows representative images from the alcohol cue tasks, both of which involved viewing 30 unique images that were presented for 6 s, with 4-s inter-stimulus intervals.

Figure 4

Significant Neural Activation to Visual Alcohol Cue Sets. One-sample t-tests were used to identify areas of significant neural activation during alcohol cue set viewing. The neural responses of the active intervention (resonance breathing) group are shown in Panels (A) (A1 task, cues viewed prior to the intervention) and (B) (A2 task, cues viewed after the intervention). The neural responses of the control intervention (vanilla task) group are shown in Panels (C) (A1 task, cues viewed prior to the intervention) and (D) (A2 task, cues viewed after the intervention). Axial slices are shown in MNI standard space at z = −6 (first slice) and every fourth subsequent slice. Images are oriented using radiological convention. Areas of significant activation are shown in red.

Figure 5

Significant Clusters of Activation in Resonance Breathing Group. Blue-cyan clusters represent regions with greater activation during A1 compared to A2 (A1 > A2), and red-yellow clusters represent regions with greater activation during A2 compared with A1 (A2 > A1). Voxels were thresholded at p < 0.05. Image is shown in MNI standard space at x = −4, y = −66, z = 6, and oriented using radiological convention.