Breathing Pattern Management Through Mental Imagery as Mental Health Rehabilitation After Dyspnea: A Narrative Review
Abstract
Dyspnea or air hunger is distressed breathing that is associated with mental awareness. Dyspnea in chronic respiratory often display anxiety or depressive symptoms. These emotional states cause a decline in the individual's quality of life and functional status. This category contributes to 1) the degree of disability related to dyspnea, and 2) the degree of impairment in lung function. In this study, we need to answer the question: Can mindfulness improve the condition of shortness of breath? Both mindfulness and shortness of breath are subjective sensations, but shortness of breath is multidimensional and multidisciplinary in nature. In this study, we conducted a scoping narrative review using three main online databases Google Scholar, PubMed, and Scopus on three main topics: respiratory system, mental imagery, and self- management (rehabilitation). We searched for observational studies and a limited number of systematic reviews and meta-analyses published up to 1968 to 2024. The specific keywords were dyspnea, oxygen, pulmonary rehabilitation, intensive care, and self-management. Dyspnea and mental imagery are the natural occurrence in most people's daily lives. Mental imagery as a cognitive ability is the motivational amplifier for promoting activities, potentially in representative outstanding emotional practices. This review emphasizes on managing the emotional distress caused by dyspnea by imagery in the brain through three different themes: 1) Attention and bodily sensations in the dyspnea, 2) Episodic memory and cognitive load in dyspnea, and 3) Managing dyspnea with mental imagery for health psychology process.
1. Wagner PD, Laravuso RB, Uhl RR, West JB. Continuous distributions of ventilation-perfusion ratios in normal subjects breathing air and 100% O2. J Clin Invest 1974; 54: 54–68.
2. Wagner PD. The physiological basis of pulmonary gas exchange: implications for clinical interpretation of arterial blood gases. Eur Respir J 2015; 45: 227-243.
3. West JB. Ventilation/perfusion inequality and overall gas exchange in computer models of the lung. Respir Physiol 1969; 7: 88–110.
4. Banzett RB, Lansing RW, Binks AP. Air Hunger: A Primal Sensation and a Primary Element of Dyspnea. Compr Physiol 2021; 11:1449-1483.
5. Michiels C. Physiological and Pathological Responses to Hypoxia004; 164: 1875–1882.
6. Post JM, Hume JR, Archer SL, Weir EK. Direct role for potassium channel inhibition in hypoxic pulmonary vasoconstriction. Am J Physiol, 1992; 262: C882–C890.
7. Kemp PJ, Lewis A, Hartness ME, Searle GJ, Miller P, O’Kelly I, et al. Airway chemotransduction: from oxygen sensor to cellular effector. Am J Respir Crit Care Med 2002; 166:S17–S24.
8. Hochachka PW. Defense strategies against hypoxia and hypothermia. Science 1986; 231: 234–241.
9. Boutilier RG, St-Pierre J. Surviving hypoxia without really dying. Comp Biochem Physiol 2000; 126: 481–490.
10. Heuch G. Hibernating myocardium. Physiol Re 1998; 78:1055–1085.
11. Budinger GR, Duranteau J, Chandel NS, Schumacker PT. Hibernation during hypoxia in cardiomyocytes: role of mitochondria as the O2 sensor. J Biol Chem 1998; 273: 3320–3326.
12. Herold, S.; Gabrielli, N.M.; Vadasz, I. Novel concepts of acute lung injury and alveolar-capillary barrier dysfunction. Am. J. Physiol.-Lung Cell Mol. Physio 2013; 305: L665–L681.
13. Dada L A, Chandel NS, Ridge KM, Pedemonte C, Bertorello AM, Sznajder JI. Hypoxia-induced endocytosis of Na,K-ATPase in alveolar epithelial cells is mediated by mitochondrial reactive oxygen species and PKC-zeta. J Clin Invest 2003; 111: 1057–1064.
14. Gusarova GA, Trejo HE, Dada LA, Briva A, Welch LC, Hamanaka RB, Mutlu GM, Chandel NS, Prakriya M, Sznajder JI. Hypoxia Leads to Na,K-ATPase Downregulation via Ca2+ Release-Activated Ca2+ Channels and AMPK Activation. Mol Cell Biol 2011; 31: 3546–3556.
15. Areza-Fegyveres R, Kairalla RA, Carvalho CCR, Nitrini R. Cognition and chronic hypoxia in pulmonary diseases. Dement Neuropsychol 2010; 4:14-22.
16. Banzett RB, Pedersen SH, Schwartzstein RM, Lansing RW. The affective dimension of laboratory dyspnea: air hunger is more unpleasant than work/effort. Am J Respir Crit Care Med 2008; 177: 1384–1390.
17. Schmid M, Banzett RB, Raux M, Morélot-Panzini C, Dangers L, Similowski T, Demoule A. Unrecognized suffering in the ICU: addressing dyspnea in mechanically ventilated patients. Intensive Care Med 2014; 40: 1–10.
18. Bellingan GJ. The pulmonary physician in critical care: the pathogenesis of ALI/ARDS. Thorax 2002; 57: 540–6.
19. Belli F, Fischer MF. Breathing shifts visuo-spatial attention Cognition 2024; 243:105685. doi: 10.1016/j.cognition2023.105685.
20. Wang X, Cui L, Ji X. Cognitive impairment caused by hypoxia: from clinical evidences to molecular mechanisms. Metab Brain Dis 2022; 37: 51–66.
21. Faull OK, Hayen A, Pattinsona KTS. Breathlessness and the body: Neuroimaging clues for the inferential leap. Cortex 2017; 95: 211–221.
22. Ten Y, Van den Bergh O, Qiu J, von Leupoldt A. The Impact of Unpredictability on Dyspnea Perception, Anxiety and Interoceptive Error Processing. Front Physiol 2019; 10: 535.
23. Benke C. Wallenfels L-M, Bleichhardt GM, Melzig CA. Health anxiety amplifies fearful responses to illness-related imagery. Sci Rep 2024; 14: 4345.doi: 10.1038/s41598-024-54985-y
24. Renner F, Murphy F, Julie L Ji, Manly T, Holmes EA. Mental imagery as a “motivational amplifier” to promote activities. Behavior Research and Therapy 2019; 114: 51-59.
25. Conroy D, Hagger MS. Imagery interventions in health behavior: A meta-analysis. Health Psychol 2018; 37:668-679.
26. Nakao M, Shirotsuki K, Sugaya N. Cognitive–behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. Biopsychosoc Med 2021; 15: 16. doi: 10.1186/s13030-021-00219-w
27. Cieri F, Esposito R. Psychoanalysis and neuroscience: The Bridge between mind and brain. Front Psychol 28 August 2019 | https://doi.org/10.3389/fpsyg.2019.01983
28. Floridou GA, Peerderman KJ, Schaefer RS. Individual differences in mental imagery in different modalities and levels of intentionality. Memory & Cognition 2022; 50: 29–44.
29. Gerits P, De Brabander B. Psychosocial predictors of psychological, neurochemical and immunological symptoms of acute stress among breast cancer patients. Psychiatry Res 1999; 85: 95–103.
30. Padgett DA, Glaser R. How stress influences the immune response. Trends in Immunology 2003; 24: 444–448.
31. Myers B, Scheimann JR, Franco-Villanueva A, Herman JP. Ascending mechanisms of stress integration: implications for brainstem regulation of neuroendocrine and behavioral stress responses. Neurosci Biobehav Rev 2017; 74(Pt B): 366–375.
32. Cunningham ET Jr, Sawchenko PE. Anatomical specificity of noradrenergic inputs to the paraventricular and supraoptic nuclei of the rat hypothalamus. J Comp Neurol 1988; 274: 60–76.
33. Armario A, Daviu N, Muñoz-Abellán C, Rabasa C, Fuentes, S, Belda X, et al. What can we know from pituitary-adrenal hormones about the nature and consequences of exposure to emotional stressors? Cell Mol Neurobiol 2012; 32: 749–758.
34. Lizarraga-Valderrama LR. Effects of essential oils on central nervous system: Focus on mental health Phytother Res 2021; 35: 657–679.
35. Zangeneh FZ, Shoushtari MS. An Overview of the Literature in Aromatherapy: Is the Olfactory System a Suitable Gateway for Modification of the Breathing Patterns (Mental Imagery & Tidal Valium) in COVID-19? Am J Phytomed Clin Ther 2021; 9: 44.
36. Balban MY, Neri E, Kogon MM,weed L, Nouriani B, Jo B et al. Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Rep Med 2023; 4: 100895. doi: 10.1016/j.xcrm.2022.100895
37. Fontanini A, Bower JM. Slow-waves in the olfactory system: an olfactory perspective on cortical rhythms. Trends Neurosci 2006; 29: 429-437.
38. Piarulli A, Zaccaro A, Laurino M, Menicucci D, De Vito, Bruschini L. A Ultra-slow mechanical stimulation of olfactory epithelium modulates consciousness by slowing cerebral rhythms in humans. Scientific Reports 2018; 8: 6581. DOI: 10.1038/s41598-018-24924-9
39. Bensafi M, Porter J, Pouliot S, Mainland J, Johnson B, Zelano C, Sobel N. Olfactomotor activity during imagery mimics that during perception. Nat Neurosci 2013; 6: 1142-1144.
40. Heck DH, Kozma R, Key LM. The rhythm of memory: How breathing shapes memory function. J Neurophysiol 2019; 122I: 563-571.
41. Zelano C, Jiang H, Zhou G, Arora N, Schuele S, Rosenow J, Gottfried JA. Nasal Respiration Entrains Human Limbic Oscillations and Modulates Cognitive Function. J Neurosci 2016; 36: 12448–12467.
42. Osaka N., Osaka M., Kondo H., Morishita M., Fukuyama H., Shibasaki H. The neural basis of executive function in working memory: an fMRI study based on individual differences. Neuro Imag. 2004; 21:623–631.
43. Herrero JL, Khuvis S, Yeagle E. Breathing above the brain stems: Volitional control and attention modulation in humans. J Neurophysiol 2018; 119: 145–159.
44. Boiten F, Frijda N H, Wientjes CJ. Emotions and respiratory patterns: Review and critical analysis. Int J of Psychophysio 1994; 17: 103–128.
45. Pribram KH. Emotions. Handbook of clinical neuropsychology. 1981, pp. 102–134, New York: Wiley
46. Diest VI,,Winters W, Devriese S,Vercamst E, Han JN, Van De Woestijne KP, Van De Bergh O. Hyperventilation beyond fight/flight: Respiratory responses during emotional imagery. Psychophysiology 2001; 38: 961–968.
47. Vlemincx E, Abelson JL, Lehrer PM, Davenport PW, Van Diest I, Van den Bergh O. Respiratory variability and sighing: a psychophysiological reset model. Biologic Psychol 2013; 93:24–32.
48. Zaman J, Van den Bergh O, Fannes S, Van Diest I. Learning to breathe? Feed forward regulation of the inspiratory motor drive. Respir Physiol & Neurobiol 2014; 2 01:1–6.
49. Jennings JR, Kamarck T, Stewart C, Eddy M, Johnson P. Alternate cardiovascular baseline assessment techniques: vanilla or resting baseline. Psychophysiology 1992; 29:742–750.
50. Areza-Fegyveres R, Kairalla RA, Carvalho CR, Nitrini R. Cognition and chronic hypoxia in pulmonary diseases. Dement Neuropsychol 2010; 4: 14–22.
51. Kida M, Imai A. Cognitive performance and event-related brain potentials under simulated high altitudes. J Appl Physiol 1993; 74: 1735–1741.
52. Zani A, Tumminelli C, Proverbio AM. Electroencephalogram (EEG) Alpha Power as a Marker of Visuospatial Attention Orienting and Suppression in Normoxia and Hypoxia. An Exploratory Study. Brain Sci 2020; 10: 140; doi:10.3390/brainsci10030140
53. Malle C, Quinette P, Laisney M, Bourrilhon C, Boissin J, Desgranges B, Eustache F, Piérard C. Working memory impairment in pilots exposed to acute hypobaric hypoxia. Aviat Space Environ Med 2013; 84: 773–779.
54. Ochi G, Kanazawa Y, Hyodo K, Suwabe K, Shimizu T, Fukuie T, Byun K, Soya H. Hypoxia-induced lowered executive function depends on arterial oxygen desaturation. J Physio Sci 2018; 68: 847–853.
55. Scholey A, Moss M, Wesnes K. Oxygen and cognitive performance: The temporal relationship between hyperoxia and enhanced memory. Psychopharm 1998; 140: 123–126.
56. Philippi N, Botzung A, Noblet V, Rousseau F, Despres O, Cretin B, Kremer S, Blanc F, Manning L. Impaired emotional autobiographical memory associated with right amygdalar-hippocampal atrophy in Alzheimer’s disease patients. Front Aging Neurosci 2015; 7: 21.
57. Pausel BM, Zlomuzica A, Kinugawa K, Mariani J,Pietrowsky R, Dere E. Perspectives on episodic-like and episodic memory. Front Behav Neurosci 2013; 7: 12pages |https://doi. org/10.3389/fnbeh.2013.00033
58. Tulving, E. (1972). Episodic and semantic memory. In E. Tulving & W. Donaldson (Eds.), Organization of memory, New York: Academic: pp. 381–40.
59. Pumar MI, Gray CR, Walsh JR, Yang IA, Rolls TR, Ward DL. Anxiety and depression—Important psychological comorbidities of COPD. J. Thoracic Disease 2014; 6. doi: 10.3978/j.issn.2072-1439.2014.09.28
60. Qiu C-J, Wu S. Depression and anxiety disorders in chronic obstructive pulmonary disease patients: Prevalence, disease impact, treatment. World J Psychiatry. Dec 19, 2024; 14(12): 1797-1803
61. Von Leupoldt A, Taube K, Lehmann K, Fritzsche A, Magnussen H. The impact of anxiety and depression on outcomes of pulmonary rehabilitation in patients with COPD. Chest 2011; 140: 730-736.
62. Arnold MT, Dolezal BA, Cooper CB. Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease: Highly Effective but Often Overlooked. Tuberc Respir Dis (Seoul). 2020; 83(4):257–267.
63. Laveneziana P, Similowski T, Morelot-Panzini C. Multidimensional approach to dyspnea. Curr Opin Pulm Med 2015; 21: 127–132.
64. Williams MT, Lewthwaite H, Paquet C, Johnston K, Olson M, Belo, LF, Pitta F, Morelot-Panzini C, Ekström M. Dyspnoea-12 and Multidimensional Dyspnea Profile: Systematic Review of Use and Properties. Journal of Pain and Symptom Management 2022; 63: e75-e87
65. Paz-Díaz H, Montes de Oca M, López JM, Celli BR. Pulmonary rehabilitation improves depression, anxiety, dyspnea and health status in patients with COPD. Am J Phys Med Rehabil 2007; 86: 30-6.
66. Hedigan F, Sheridan H, Sasse A. Benefit of inhalation aromatherapy as a complementary treatment for stress and anxiety in a clinical setting – A systematic review. Complementary Therapies in Clinical Practice 2023; 52: 101750 https://doi.org/10.1016/j.ctcp.2023.101750
67. Okada K, Shimatani K. Effect of olfactory stimulation from aromatherapy on the autonomic nervous activity during aerobic exercises. Nature Scientifc Reports 2024; 14:11198 | https://doi.org/10.1038/s41598-024-61732-w
69. Barclay RE, Stevenson TJ, Poluha W, Semenko B, Schubert J, Mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke. Meta-Analysis Cochrane Database Syst Rev. 2020; 5(5):CD005950.
doi: 10.1002/14651858.CD005950.pub5.
70 Öztekin GG, Gómez-Salgado J. Yıldırım M. Future anxiety, depression and stress among undergraduate students: psychological flexibility and emotion regulation as mediators. Front. Psychol. 2025; 16. | https://doi.org/10.3389/fpsyg.2025.1517441
71. Bhattacharya S, Hofman S. Mindfulness-based interventions for anxiety and depressionClinics in Integrated Care. 2023; 16: 100138. https://doi.org/10.1016/j.intcar.2023.100138
2. Wagner PD. The physiological basis of pulmonary gas exchange: implications for clinical interpretation of arterial blood gases. Eur Respir J 2015; 45: 227-243.
3. West JB. Ventilation/perfusion inequality and overall gas exchange in computer models of the lung. Respir Physiol 1969; 7: 88–110.
4. Banzett RB, Lansing RW, Binks AP. Air Hunger: A Primal Sensation and a Primary Element of Dyspnea. Compr Physiol 2021; 11:1449-1483.
5. Michiels C. Physiological and Pathological Responses to Hypoxia004; 164: 1875–1882.
6. Post JM, Hume JR, Archer SL, Weir EK. Direct role for potassium channel inhibition in hypoxic pulmonary vasoconstriction. Am J Physiol, 1992; 262: C882–C890.
7. Kemp PJ, Lewis A, Hartness ME, Searle GJ, Miller P, O’Kelly I, et al. Airway chemotransduction: from oxygen sensor to cellular effector. Am J Respir Crit Care Med 2002; 166:S17–S24.
8. Hochachka PW. Defense strategies against hypoxia and hypothermia. Science 1986; 231: 234–241.
9. Boutilier RG, St-Pierre J. Surviving hypoxia without really dying. Comp Biochem Physiol 2000; 126: 481–490.
10. Heuch G. Hibernating myocardium. Physiol Re 1998; 78:1055–1085.
11. Budinger GR, Duranteau J, Chandel NS, Schumacker PT. Hibernation during hypoxia in cardiomyocytes: role of mitochondria as the O2 sensor. J Biol Chem 1998; 273: 3320–3326.
12. Herold, S.; Gabrielli, N.M.; Vadasz, I. Novel concepts of acute lung injury and alveolar-capillary barrier dysfunction. Am. J. Physiol.-Lung Cell Mol. Physio 2013; 305: L665–L681.
13. Dada L A, Chandel NS, Ridge KM, Pedemonte C, Bertorello AM, Sznajder JI. Hypoxia-induced endocytosis of Na,K-ATPase in alveolar epithelial cells is mediated by mitochondrial reactive oxygen species and PKC-zeta. J Clin Invest 2003; 111: 1057–1064.
14. Gusarova GA, Trejo HE, Dada LA, Briva A, Welch LC, Hamanaka RB, Mutlu GM, Chandel NS, Prakriya M, Sznajder JI. Hypoxia Leads to Na,K-ATPase Downregulation via Ca2+ Release-Activated Ca2+ Channels and AMPK Activation. Mol Cell Biol 2011; 31: 3546–3556.
15. Areza-Fegyveres R, Kairalla RA, Carvalho CCR, Nitrini R. Cognition and chronic hypoxia in pulmonary diseases. Dement Neuropsychol 2010; 4:14-22.
16. Banzett RB, Pedersen SH, Schwartzstein RM, Lansing RW. The affective dimension of laboratory dyspnea: air hunger is more unpleasant than work/effort. Am J Respir Crit Care Med 2008; 177: 1384–1390.
17. Schmid M, Banzett RB, Raux M, Morélot-Panzini C, Dangers L, Similowski T, Demoule A. Unrecognized suffering in the ICU: addressing dyspnea in mechanically ventilated patients. Intensive Care Med 2014; 40: 1–10.
18. Bellingan GJ. The pulmonary physician in critical care: the pathogenesis of ALI/ARDS. Thorax 2002; 57: 540–6.
19. Belli F, Fischer MF. Breathing shifts visuo-spatial attention Cognition 2024; 243:105685. doi: 10.1016/j.cognition2023.105685.
20. Wang X, Cui L, Ji X. Cognitive impairment caused by hypoxia: from clinical evidences to molecular mechanisms. Metab Brain Dis 2022; 37: 51–66.
21. Faull OK, Hayen A, Pattinsona KTS. Breathlessness and the body: Neuroimaging clues for the inferential leap. Cortex 2017; 95: 211–221.
22. Ten Y, Van den Bergh O, Qiu J, von Leupoldt A. The Impact of Unpredictability on Dyspnea Perception, Anxiety and Interoceptive Error Processing. Front Physiol 2019; 10: 535.
23. Benke C. Wallenfels L-M, Bleichhardt GM, Melzig CA. Health anxiety amplifies fearful responses to illness-related imagery. Sci Rep 2024; 14: 4345.doi: 10.1038/s41598-024-54985-y
24. Renner F, Murphy F, Julie L Ji, Manly T, Holmes EA. Mental imagery as a “motivational amplifier” to promote activities. Behavior Research and Therapy 2019; 114: 51-59.
25. Conroy D, Hagger MS. Imagery interventions in health behavior: A meta-analysis. Health Psychol 2018; 37:668-679.
26. Nakao M, Shirotsuki K, Sugaya N. Cognitive–behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. Biopsychosoc Med 2021; 15: 16. doi: 10.1186/s13030-021-00219-w
27. Cieri F, Esposito R. Psychoanalysis and neuroscience: The Bridge between mind and brain. Front Psychol 28 August 2019 | https://doi.org/10.3389/fpsyg.2019.01983
28. Floridou GA, Peerderman KJ, Schaefer RS. Individual differences in mental imagery in different modalities and levels of intentionality. Memory & Cognition 2022; 50: 29–44.
29. Gerits P, De Brabander B. Psychosocial predictors of psychological, neurochemical and immunological symptoms of acute stress among breast cancer patients. Psychiatry Res 1999; 85: 95–103.
30. Padgett DA, Glaser R. How stress influences the immune response. Trends in Immunology 2003; 24: 444–448.
31. Myers B, Scheimann JR, Franco-Villanueva A, Herman JP. Ascending mechanisms of stress integration: implications for brainstem regulation of neuroendocrine and behavioral stress responses. Neurosci Biobehav Rev 2017; 74(Pt B): 366–375.
32. Cunningham ET Jr, Sawchenko PE. Anatomical specificity of noradrenergic inputs to the paraventricular and supraoptic nuclei of the rat hypothalamus. J Comp Neurol 1988; 274: 60–76.
33. Armario A, Daviu N, Muñoz-Abellán C, Rabasa C, Fuentes, S, Belda X, et al. What can we know from pituitary-adrenal hormones about the nature and consequences of exposure to emotional stressors? Cell Mol Neurobiol 2012; 32: 749–758.
34. Lizarraga-Valderrama LR. Effects of essential oils on central nervous system: Focus on mental health Phytother Res 2021; 35: 657–679.
35. Zangeneh FZ, Shoushtari MS. An Overview of the Literature in Aromatherapy: Is the Olfactory System a Suitable Gateway for Modification of the Breathing Patterns (Mental Imagery & Tidal Valium) in COVID-19? Am J Phytomed Clin Ther 2021; 9: 44.
36. Balban MY, Neri E, Kogon MM,weed L, Nouriani B, Jo B et al. Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Rep Med 2023; 4: 100895. doi: 10.1016/j.xcrm.2022.100895
37. Fontanini A, Bower JM. Slow-waves in the olfactory system: an olfactory perspective on cortical rhythms. Trends Neurosci 2006; 29: 429-437.
38. Piarulli A, Zaccaro A, Laurino M, Menicucci D, De Vito, Bruschini L. A Ultra-slow mechanical stimulation of olfactory epithelium modulates consciousness by slowing cerebral rhythms in humans. Scientific Reports 2018; 8: 6581. DOI: 10.1038/s41598-018-24924-9
39. Bensafi M, Porter J, Pouliot S, Mainland J, Johnson B, Zelano C, Sobel N. Olfactomotor activity during imagery mimics that during perception. Nat Neurosci 2013; 6: 1142-1144.
40. Heck DH, Kozma R, Key LM. The rhythm of memory: How breathing shapes memory function. J Neurophysiol 2019; 122I: 563-571.
41. Zelano C, Jiang H, Zhou G, Arora N, Schuele S, Rosenow J, Gottfried JA. Nasal Respiration Entrains Human Limbic Oscillations and Modulates Cognitive Function. J Neurosci 2016; 36: 12448–12467.
42. Osaka N., Osaka M., Kondo H., Morishita M., Fukuyama H., Shibasaki H. The neural basis of executive function in working memory: an fMRI study based on individual differences. Neuro Imag. 2004; 21:623–631.
43. Herrero JL, Khuvis S, Yeagle E. Breathing above the brain stems: Volitional control and attention modulation in humans. J Neurophysiol 2018; 119: 145–159.
44. Boiten F, Frijda N H, Wientjes CJ. Emotions and respiratory patterns: Review and critical analysis. Int J of Psychophysio 1994; 17: 103–128.
45. Pribram KH. Emotions. Handbook of clinical neuropsychology. 1981, pp. 102–134, New York: Wiley
46. Diest VI,,Winters W, Devriese S,Vercamst E, Han JN, Van De Woestijne KP, Van De Bergh O. Hyperventilation beyond fight/flight: Respiratory responses during emotional imagery. Psychophysiology 2001; 38: 961–968.
47. Vlemincx E, Abelson JL, Lehrer PM, Davenport PW, Van Diest I, Van den Bergh O. Respiratory variability and sighing: a psychophysiological reset model. Biologic Psychol 2013; 93:24–32.
48. Zaman J, Van den Bergh O, Fannes S, Van Diest I. Learning to breathe? Feed forward regulation of the inspiratory motor drive. Respir Physiol & Neurobiol 2014; 2 01:1–6.
49. Jennings JR, Kamarck T, Stewart C, Eddy M, Johnson P. Alternate cardiovascular baseline assessment techniques: vanilla or resting baseline. Psychophysiology 1992; 29:742–750.
50. Areza-Fegyveres R, Kairalla RA, Carvalho CR, Nitrini R. Cognition and chronic hypoxia in pulmonary diseases. Dement Neuropsychol 2010; 4: 14–22.
51. Kida M, Imai A. Cognitive performance and event-related brain potentials under simulated high altitudes. J Appl Physiol 1993; 74: 1735–1741.
52. Zani A, Tumminelli C, Proverbio AM. Electroencephalogram (EEG) Alpha Power as a Marker of Visuospatial Attention Orienting and Suppression in Normoxia and Hypoxia. An Exploratory Study. Brain Sci 2020; 10: 140; doi:10.3390/brainsci10030140
53. Malle C, Quinette P, Laisney M, Bourrilhon C, Boissin J, Desgranges B, Eustache F, Piérard C. Working memory impairment in pilots exposed to acute hypobaric hypoxia. Aviat Space Environ Med 2013; 84: 773–779.
54. Ochi G, Kanazawa Y, Hyodo K, Suwabe K, Shimizu T, Fukuie T, Byun K, Soya H. Hypoxia-induced lowered executive function depends on arterial oxygen desaturation. J Physio Sci 2018; 68: 847–853.
55. Scholey A, Moss M, Wesnes K. Oxygen and cognitive performance: The temporal relationship between hyperoxia and enhanced memory. Psychopharm 1998; 140: 123–126.
56. Philippi N, Botzung A, Noblet V, Rousseau F, Despres O, Cretin B, Kremer S, Blanc F, Manning L. Impaired emotional autobiographical memory associated with right amygdalar-hippocampal atrophy in Alzheimer’s disease patients. Front Aging Neurosci 2015; 7: 21.
57. Pausel BM, Zlomuzica A, Kinugawa K, Mariani J,Pietrowsky R, Dere E. Perspectives on episodic-like and episodic memory. Front Behav Neurosci 2013; 7: 12pages |https://doi. org/10.3389/fnbeh.2013.00033
58. Tulving, E. (1972). Episodic and semantic memory. In E. Tulving & W. Donaldson (Eds.), Organization of memory, New York: Academic: pp. 381–40.
59. Pumar MI, Gray CR, Walsh JR, Yang IA, Rolls TR, Ward DL. Anxiety and depression—Important psychological comorbidities of COPD. J. Thoracic Disease 2014; 6. doi: 10.3978/j.issn.2072-1439.2014.09.28
60. Qiu C-J, Wu S. Depression and anxiety disorders in chronic obstructive pulmonary disease patients: Prevalence, disease impact, treatment. World J Psychiatry. Dec 19, 2024; 14(12): 1797-1803
61. Von Leupoldt A, Taube K, Lehmann K, Fritzsche A, Magnussen H. The impact of anxiety and depression on outcomes of pulmonary rehabilitation in patients with COPD. Chest 2011; 140: 730-736.
62. Arnold MT, Dolezal BA, Cooper CB. Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease: Highly Effective but Often Overlooked. Tuberc Respir Dis (Seoul). 2020; 83(4):257–267.
63. Laveneziana P, Similowski T, Morelot-Panzini C. Multidimensional approach to dyspnea. Curr Opin Pulm Med 2015; 21: 127–132.
64. Williams MT, Lewthwaite H, Paquet C, Johnston K, Olson M, Belo, LF, Pitta F, Morelot-Panzini C, Ekström M. Dyspnoea-12 and Multidimensional Dyspnea Profile: Systematic Review of Use and Properties. Journal of Pain and Symptom Management 2022; 63: e75-e87
65. Paz-Díaz H, Montes de Oca M, López JM, Celli BR. Pulmonary rehabilitation improves depression, anxiety, dyspnea and health status in patients with COPD. Am J Phys Med Rehabil 2007; 86: 30-6.
66. Hedigan F, Sheridan H, Sasse A. Benefit of inhalation aromatherapy as a complementary treatment for stress and anxiety in a clinical setting – A systematic review. Complementary Therapies in Clinical Practice 2023; 52: 101750 https://doi.org/10.1016/j.ctcp.2023.101750
67. Okada K, Shimatani K. Effect of olfactory stimulation from aromatherapy on the autonomic nervous activity during aerobic exercises. Nature Scientifc Reports 2024; 14:11198 | https://doi.org/10.1038/s41598-024-61732-w
69. Barclay RE, Stevenson TJ, Poluha W, Semenko B, Schubert J, Mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke. Meta-Analysis Cochrane Database Syst Rev. 2020; 5(5):CD005950.
doi: 10.1002/14651858.CD005950.pub5.
70 Öztekin GG, Gómez-Salgado J. Yıldırım M. Future anxiety, depression and stress among undergraduate students: psychological flexibility and emotion regulation as mediators. Front. Psychol. 2025; 16. | https://doi.org/10.3389/fpsyg.2025.1517441
71. Bhattacharya S, Hofman S. Mindfulness-based interventions for anxiety and depressionClinics in Integrated Care. 2023; 16: 100138. https://doi.org/10.1016/j.intcar.2023.100138
| Files | ||
| Issue | Articles in Press: Vol 64 No 03 (2026) | |
| Section | Review Article(s) | |
| Keywords | ||
| Mental imagery Respiratory system Dyspnea Emotional states Health psychology | ||
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How to Cite
1.
Azizi M, Zangeneh F. Breathing Pattern Management Through Mental Imagery as Mental Health Rehabilitation After Dyspnea: A Narrative Review. Acta Med Iran. 2026;.
