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Cited by 14Stress Responses and CortisolHeart Rate Variability and Autonomic ControlMindfulness and Compassion Interventions

Slow breathing reduces biomarkers of stress in response to a virtual reality active shooter training drill

Open access
Dillard, Courtney C., Martaindale, Hunter, Hunter, Stacy D., McAllister, Matthew J.·2023·Healthcare
DOI 10.3390/healthcare11162351PMC PMC10454504
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Abstract

Tactical occupations regularly encounter life-threatening situations while on duty. Although these occupations are often trained to utilize slow breathing (SB) during intense stress, there is no evidence supporting the effects on markers of stress in response to a virtual reality active shooter training drill (VR-ASD). The purpose of the study was to determine the impact of acute SB on biomarkers of stress in response to a VR-ASD. Seventy-nine (n = 79) subjects performed either slow breathing method 1 (SB1), slow breathing method 2 (SB2), or normal breathing (control) for five minutes, both pre- and post-VR-ASD. Saliva samples were analyzed for stress markers, including α-amylase (sAA) and secretory immunoglobulin-A (SIgA). Both methods of SB resulted in significantly lower sAA concentrations at 5 (p < 0.001) and 30 min post-VR-ASD (SB1: p = 0.008; SB2: p < 0.001) compared to the control. In the control condition, the sAA concentrations were significantly elevated 5 min post-VR-ASD (p < 0.001) but did not change across time in SB1 or SB2 (p > 0.05). Thus, both SB1 and SB2 reduced the sAA response and resulted in lower concentrations post-VR-ASD. This study was pre-registered as a clinical trial (“Impact of Breathing Interventions on Stress Markers”; NCT05825846).

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Crossref · 10.3390/healthcare11162351

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  • Both box breathing and the reset breath have demonstrated reductions in stress biomarkers and improvements in mood and composure following stressful events.

    “Both techniques (i.e., box breathing and the reset breath) have demonstrated reductions in stress biomarkers (e.g., salivary alpha-amylase) and improvements in mood and composure following stressful events [14,18].”

    From Box breathing and prolonged exhalation reduces markers of physiological stress reactivity in response to a virtual trier social stress test (2026) · cites this paper as [14]

    The Breathing Interventions section describes SB1 with four-second inhale, pause, exhale, and pause phases, consistent with box breathing, and SB2 as a different slow-breathing pattern; it does not identify SB2 as the reset breath. The Discussion reports lower salivary alpha-amylase after the virtual-reality drill with both interventions. The State Anxiety Inventory Results found no treatment effect, however, so this paper does not establish improved mood or composure from either technique. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Variations of box breathing have demonstrated reduced salivary biomarkers of stress from 5 min of 4:2:4 and 4:2 breathing.

    “Variations of box breathing, also popularized as ‘tactical or combat breathing’ among first responder populations [23] have demonstrated reduced salivary biomarkers of stress from 5 min of 4:2:4 (4-s inhale, 2-s pause, 4-s exhale) as well as 4:2 (4-s inhale, 2-s exhale) [14].”

    From Box breathing and prolonged exhalation reduces markers of physiological stress reactivity in response to a virtual trier social stress test (2026) · cites this paper as [14]

    Methods §2.4 describes five-minute 4:2 breathing and a second intervention with a four-second inhale, two-second pause, four-second exhale, and another two-second pause. The Discussion reports that both reduced salivary α-amylase after the drill. The claim omits the final pause from the first intervention, describing it as 4:2:4 rather than 4:2:4:2. Page numbers are not provided in our copy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Dillard et al. [14] reported reduced sAA and no impact on SIgA concentrations from slow breathing in response to acute stress.

    “The present findings align with prior research from Dillard et al. [14] who reported reduced sAA and no impact on SIgA concentrations from slow breathing in response to acute stress.”

    From Box breathing and prolonged exhalation reduces markers of physiological stress reactivity in response to a virtual trier social stress test (2026) · cites this paper as Dillard et al. [14]

  • For SIgA, the significant main effects for time without an interaction suggest that SIgA fluctuations across the session were not differentially modulated by the breathing interventions, consistent with findings from Dillard et al. [14].

    “For SIgA, the significant main effects for time without an interaction suggest that SIgA fluctuations across the session were not differentially modulated by the breathing interventions, consistent with findings from Dillard et al. [14].”

    From Box breathing and prolonged exhalation reduces markers of physiological stress reactivity in response to a virtual trier social stress test (2026) · cites this paper as Dillard et al. [14]

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Cites

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Research works printed but not linked: 1

  1. [47]Vadhan J. Tadi P. Physiology, Herring Breuer Reflex StatPearls Publishing Treasure Island, FL, USA 2023 31869189

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Authors
Dillard, C. C., Martaindale, H., Hunter, S. D., & McAllister, M. J.
Affiliations
  • Texas State University (US)
  • ALERRT Center, Texas State University, San Marcos, TX 78666, USA
Corresponding author
McAllister, Matthew J.
ORCID
Venue
Healthcare
Publisher
MDPI AG
Published
2023-08-21
Volume
11
Issue
16
Pages
2351
ISSN
2227-9032 (ISSN-L)
DOI
10.3390/healthcare11162351
PMC
PMC10454504
OpenAlex
W4386028558
Cited by
13
References
72
Citations by year
2026: 3 · 2025: 5 · 2024: 5
FWCI
2.42
Type
journal article
Language
en
Open access
Licence
Locations
  • Healthcare (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
U.S. DOJ—Office of Community Oriented Policing Services (COPS Office) (15JCOPS-21-GK-02120-SPAS)
Topics
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Keywords
slow-paced breathing, stress biomarkers, alpha-amylase, secretory IgA, acute stress response, breathing interventions, salivary biomarkers, occupational stress

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