Abstract
Background Dysfunctional breathing is common among people with and without primary respiratory pathology. While anxiety can contribute to dysfunctional breathing, the underpinning mechanism is unclear. One explanation is that anxiety induces conscious, vigilant monitoring of breathing, disrupting “automatic” breathing mechanics. We validated a new tool that quantifies such breathing-related “vigilance”: the Breathing Vigilance Questionnaire (Breathe-VQ).
Methods 323 healthy adults (mean (range) age 27.3 (18–71) years; 161 males) were analysed. We developed an initial Breathe-VQ (11 items, 1–5 Likert scale) based on the Pain Vigilance and Awareness Scale, using feedback from the target population and clinicians. At baseline, participants completed the Breathe-VQ, Nijmegen Questionnaire (NQ), State-Trait Anxiety Inventory form 2 and Movement-Specific Reinvestment Scale (assessing general conscious processing). 83 people repeated the Breathe-VQ 3 weeks later.
Results Five items were removed based on item-level analysis. The resulting six-item Breathe-VQ questionnaire (score range 6–30) has excellent internal (α=0.892) and test–retest reliability (intraclass correlation 0.810), a minimal detectable change of 6.5 and no floor/ceiling effects. Validity was evidenced by significant positive correlations with trait anxiety and conscious processing scores (r=0.35–0.46). Participants at high risk of having dysfunctional breathing (NQ >23; n=76) had significantly higher Breathe-VQ score (mean±sd 19.1±5.0) than low-risk peers (n=225; mean±sd 13.8±5.4; p<0.001). In this “high risk of dysfunctional breathing” group, Breathe-VQ and NQ scores were significantly associated (p=0.005), even when controlling for risk factors (e.g. trait anxiety).
Conclusions The Breathe-VQ is a valid and reliable tool to measure breathing vigilance. High breathing vigilance may contribute to dysfunctional breathing and could represent a therapeutic target. Further research is warranted to test Breathe-VQ's prognostic value and assess intervention effects.
Abstract
Anxious, vigilant monitoring of breathing may contribute to dysfunctional breathing. A short self-reported outcome measure is validated that allows researchers and clinicians to measure how much individuals display such breathing-specific vigilance. http://bit.ly/3JTs57Y
Footnotes
Conflict of interest: The authors declare that they have no competing interests.
This article has an editorial commentary: https://doi.org/10.1183/13993003.00629-2023
Support statement: This research was supported by Brunel University London, publicly funded by Research England.
- Received July 19, 2022.
- Accepted March 24, 2023.
- Copyright ©The authors 2023. For reproduction rights and permissions contact permissions{at}ersnet.org