Investigating the Synergetic Restorative Effects of Box-Breathing

Investigating the Synergetic Restorative Effects of Box-Breathing and Nature Sounds on Enhancing Cognitive Functioning among Birkbeck College Masters Students

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Abstract

The aim of this experiment was to determine influence of box-breathing and nature sound on the cognitive functioning among Birkbeck College Masters Students. As evidenced by attention restoration theory (ART) that cognitive fatigue is a result of stress of carrying out certain tasks for a long period of time, so exposure to natural environment could mitigate that stress and enhance the cognitive functioning of the students. Thus, the study hypotheised that there is a significant impact of box-breathing and nature sounds on cognitive functioning of the students. For this purpose, 17 students from Birkbeck College were recruited and were divided into four groups ;(1) one group was engaged into the box-breathing only and is denoted as BB (2) second group performed box-breathing along with nature sounds and is denoted as NSxNS (3) third group only perfumed normal breath and is denoted as NB (4) and last fourth group just heard nature sounds and is denoted as NS. For statistical analysis, two-way ANOVA was used that allows to determine influence of a four different conditions on cognitive functioning of the students; where independent variable is defined as a group and dependent variable is defined as total score. The findings of the experiment suggests that there is statistically insignificant impact of box-breathing and nature sound on the cognitive functioning of the students. This implies that if they perform box-breathing, or box-breathing along with nature sounds or just nature sounds or they just breathe normally; it does not affect their cognitive functioning of the students. Therefore, the findings of the experiment could be concluded as that there is no influence of box-breathing and nature sound on the cognitive functioning among the Birkbeck College Masters Students. 

Introduction 

Background and context 

Cognitive functioning means effective and efficient performance on tasks that are necessary for daily functioning, such as attention, working memory, problem solving, and executive functioning (Diamond, 2013). In postgraduate students specifically, it is imperative to sustain high cognitive functions given the challenge in cognitive processing and time management intricacies of academic activities (Evans, Pass, McDonnell & Baysal, 2020). The reason why working memory or the ability to temporarily store and manipulate information is crucial for processes like problem solving or other high-level reasoning (Baddeley, 2017). Nevertheless, stress and cognitive load can undermine these functions, thus decreasing efficiency (Sandi, 2013). Although participants in this study comprised postgraduate students and were thus more likely to multitask, the results suggest that multitasking hampers their ability to pay attention to health information, whether due to cognitive exhaustion from working, social activities, or financial strain. Improving the cognitive skills is crucial as cognitive status determines the learning achievements, overall mood and mental state (Borella et al., 2017). 

Box-Breathing and Its Benefits

Box-breathing, also known as square breathing, is a controlled breathing technique involving four equal phases: Inspiration, breath retention, expiration, and inspiration again and retention with equal intervals of approximately four seconds. This type of practice is based on mindfulness and also can contribute to the stabilization of the activity of the autonomic nervous system, which causes the state of relaxation (Kim et al., 2021). The effect of box breathing in decreasing the concentration of cortisol in relation to stress is paralleled by favorable changes in the physiological and cognitive state (Kox et al., 2020). It is important to note that training and using controlled breathing strategies such us box-breathing was found to improve concentration and attention, both of which are central to activities requiring continuous cognitive processes (Jerath et al., 2019). Other cognitive benefits include enhancements in working memory, a phenomenon attributed to the decline in anxious feelings and excessive thoughts (Santos et al., 2022). This is applicable to the backwards digit span test, because box-breathing would improve the brain resources required for storage and manipulation of information to perform well in memory demanding exercises.

Nature Sounds and Cognitive Functioning

Background music including nature sounds like the noises of the ocean, bird songs, and rain drops are normally used in clinical and relaxation situations for health reasons. These noises are linked to relaxation and rejuvenation purposes and used in meditation sessions and relaxation treatments (Medvedev et al., 2020). When exposed to nature sounds, stress levels and mental fatigue are caused to reduce while focus and cognitive performance enhanced (van Praag et al., 2021). Such effects are given by the Attention Restoration Theory (ART), according to which natural environments make it easier to renew our cognitive resources (Kaplan & Berman, 2019). Similarly, differing with modern music, nature sounds help people to change from directed attention fatigue and recover such mental faculties as working memory and attention (Mariani et al., 2022). These restorative effects make nature sounds an efficient way of improving performance among learners because of the competing academic environment.

The Synergistic Effects of Box-Breathing and Nature Sounds; Rationale for combining the interventions

Integrating the box-breathing technique with the background music of nature sounds can be considered as a valuable practice to improve cognitive performance. It is now known in literature that both interventions can in themselves decrease stress, enhance attention, and facilitate cognition (Coulombe et al., 2021; Gao et al., 2022). The effects of box-breathing are associated with a lower cortisol level and enhanced attention, while the effects of nature sounds are associated with relaxation and recovery from cognitive fatigue through attention restoration processes (Jerath et al., 2019; Medvedev et al., 2020). When put together, these interventions may be cumulative or even exhibit a multiplicative impact toward enhancing the positive effects on critical mental functions like working memory and focus. Although studies have been conducted on each of the interventions individually, no research has linked the effects of the interventions on cognitive performance. This study aims at filling this gap through providing perspectives that reveal how these two traditional instructional methods can be integrated to facilitate cognition enhancement especially amidst academic pressure.

Problem statement 

A cumulative effect associated with academia and the higher cognitive load of postgraduate students is the adverse effects of stress on attention, working memory, and other aspects of cognitive processing (Shields et al., 2017). Previous approaches of stress and cognitive workload include time active methods like mindfulness and relaxation techniques that practice have been deemed effective but, unfortunately, are not widely used frequently due to the unavailability of time or lack of knowledge (Regehr et al., 2013). Though, it has been seen in studies of Gerritsen & Band (2018) and Medvedev et al. (2020) that the techniques applied in the present study, both box-breathing and nature sounds, are efficient in reducing stress and improving the cognitive performance individually. There has been relatively low research conducted on the combined effect of these interventions which therefore leave a gap on manner through which individuals’ cognitive ability under stress can be best enhanced. The purpose of this research will therefore seek to determine the effect of the combined box breathing and nature sounds as compared to the single interventions to help the students improve their academic performance.

Rationale of the study 

It is vital for enhancing cognitive performance in learning contexts where learners are often exposed to elevated levels of stress and cognitive requirements. For instance, a study on the experience of postgraduate students reported high levels of stress, particularly due to work demands and academic load, which affected learning and health outcomes (Beiter et al., 2015). The findings of this study present naturalistic and relatively simple treatment that can be used in paralleling mental acuity and working memory under stress. Notably, earlier studies reported on stress-reducing and enhanced focus benefits of both types of interventions but unknown in combination (Jerath et al., 2019; van Praag et al., 2021). These insights can benefit student affairs, providing documented possibilities to enhance learning contexts to orders student success.

Theoretical and empirical underpinning 

The theoretical framework for this study is based on the Attention Restoration Theory (ART) which suggests that natural environments or environmental sounds like nature help to restore cognition and reduce mental fatigue in the directed attention systems for a period (Kaplan & Berman, 2010). These findings indicate to ART that the nature is a low-effort form of response, described as soft fascination, which replenishes the cognitive resources known as the working memory that is crucial in problem solving. Several academic studies exist which corroborate each of the individual benefits of box breathing as well as nature sounds on cognitive operations. For instance, the box-breathing technique that was investigated by Gerritsen & Band (2018) was found to control the ANS and reduce cortisol levels that enhances attention and working memory. In the same vein, Medvedev et al (2020) showed that nature sounds enhance restoration and cognitive rehabilitation, which aligns with the tenets of ART. However, a number of these interventions have not been carried out simultaneously and therefore this area is lacking in current research. The purpose of this research is to analyze how the integration of those approaches may have an additive effect and provide a better improvement of cognitive functions than the application of each method separately.

Aim of the study 

The goal of this study is to examine the modulating impact of box breathing and nature sound on cognitive performance with emphasis on working memory and attention among postgraduate students of Birkbeck College. Therefore, the study aims at comparing these interventions with and without interaction to establish whether they improve cognitive performance under academic stress.

Hypothesis

We predict that participants will perform better on the cognitive function test, after both box breathing and nature sound condition. We predict that the participants will perform best in the box breathing X sound condition.

Research question 

1. Does the combination of box-breathing and nature sounds have a greater impact on enhancing cognitive functioning, as measured by the backward digit span test, than either intervention alone or no intervention at all?

Method

Design 

The study used a 2x2 factorial design to investigate the impact of the box-breathing and nature sounds on the working memory performance. The two independent variables used in the study were Exercise Type (Box Breathing -Performing Normal Breathing exercise and Box Breathing) and Sound (Listening to nature sounds and no sound). The dependent variable was cognitive performance and it was assessed with the backward digit span test. The objective was to compare whether these interventions having such effect on the recipient and whether their use cumulatively has an additive or synergistic effect on cognitive skills. A 2x2 between subject’s design ANOVA was used for the data analysis with the view of determining the main effect of a given independent variable and the interaction effect of the different independent variables.

Participants 

For the study 18 participants above the age of eighteen were sampled and recruited to participate in the study. Exclusion criteria include a history of neurological disease, vision or hearing abnormalities if not corrected at the time of the study. Participants were randomly assigned to one of four experimental groups;

• Box-Breathing only (BB)
• Nature Sound with Box Breathing (NSxNS)
• Normal Breathing (NB)
• Nature Sounds only (NS)

A demographic analysis was conducted whereby the age and gender of the participants were obtained. Thus, exclusion criteria were having different than normal vision or hearing ability or if the participant either could be interrupted or was in noisy environment during the experiment. The descriptive analysis is performed to evaluate the number of participants and their relative divisions in different groups. 

Materials

Stimuli 

Box-Breathing Video

The box-breathing video which was 7 minutes long showed an illustration of timed breathing exercises. The video showed a square with a moving dot; the participants were asked to breathe in, hold their breath and then breathe out and hold it at the predetermined intervals of the music. The box-breathing technique, popularly referred to as square breathing, has been noted to assist in controlling the ANS, and in a process, help to lower stress levels and increase focus (Brown & Gerbarg, 2012). The goal of this technique is to enhance cortical activation with the help of reducing the level of stress reaction and providing relaxation (Yim, 2016).

Nature Sounds

Soothing natural sounds such as ocean, birds and rain sounds were employed through audio stimulation to establish a tranquility to the audio environment. Natural sounds have been reported to enhance relaxation and optimize cognitive performance by relaxing the mind and reducing attentiveness (Harrison & Schiffman, 2006). The studies show that exposure to such sounds enhances working memories, on the basis of attention restoration theory (Crawford, 2021).

Backward Digit Span Test

In this study, the backward digit span test was used in order to assess working memory and cognitive abilities. This task involved participants in reversing sequences of digits that is, a standard test of working memory capacity and attention as defined by Conway et al., (2005). This test was conducted on the participants before and after the intervention so as to compare the effects of the box-breathing and nature sounds conditions on their cognitive abilities.

Control and Balancing Procedures

Random Assignment

The participants were randomly assigned to one of four conditions: Box-Breathing (BB), Box-Breathing with Nature Sounds (NSxNS), Normal Breathing (NB), or Nature Sounds only (NS). Due to randomization, bias was reduced and nuisances that may influence the results of the study were eliminated (Graham et al., 2012).

Standardization

Finally, to control for any ways in which manipulations may have varied across participants in their condition, video and audio stimuli were kept constant. This approach had the benefit of insuring that if any effects were detected they could be traced back to the interventions rather than fluctuations in Stimulus Presentation (Kraemer, et al, 2006).

Software

For designing and running the experiment the aid of Gorilla Experiment Builder was taken. This platform allowed for the design of the interactive stimuli, data capturing and the process of randomization. It made it possible to standardize the experimental procedure and to take proper records of data (Palan & Schitter, 2018).

Procedure 

Pre-Experiment Preparation

The participants received an email with an activated link to access the experiment, as well as instructions to complete the task on their own laptops, minimizing interference and background noise. Informed consent that utilized Gorilla provided assurance to the participants about the nature of the study, and participated willingly before continuing the study process (Palan & Schitter, 2018).

Screening Questionnaire

The utilization of a pre-experiment questionnaire as a respondent-derived instrument is important because it gives some basic demographic and health information. They provided self-identified age, gender, visual, and auditory impairments and ensure that they were in a quiet area and would not be interrupted throughout the session. To do this, this step aided in identifying participants who represented the study and at the same time, control for outside factors that might infringe on the study (Lazarus et al., 2018).

Pre-Test Measurement

Cognitive abilities test that was employed involved the backward digit span test was first administered to the participants in order to obtain a baseline measure. This was the Working Memory and Attention test that involved recalling a specific sequence of digits in the reverse order (Conway, et al., 2005). Such a baseline was important for determining the variation in cognitive abilities after the intervention.

Intervention Phase

Participants were randomly assigned to one of four conditions:

The video stimulus was homogeneous within subjects and heterogeneous across conditions so as to provide consistency of the intervention but with variation in the context (Graham et al., 2012).

Post-Test Measurement

The second test was the backward digit span that was completed by participants following the end of the intervention so as to determine the effects of the intervention on the participants’ cognitive status (Conway et al., 2005).

Debriefing

Participants were given a debriefing sheet, containing information about the study, its purpose, and the results after the experiment was conducted. This debriefing helped the participants in the research to appreciate the goals and findings of the study (American Psychological Association, 2017).

Results

Descriptive Statistics

In terms of experimental data, there were four groups of participants; (1) one group was engaged into the box-breathing only and is denoted as BB (2) second group performed box-breathing along with nature sounds and is denoted as NSxNS (3) third group only perfumed normal breath and is denoted as NB (4) and last fourth group just heard nature sounds and is denoted as NS. Table 1 presents the each group along with participants in each group

Table 1 Between-Subjects Factors

All group were shown different same videos and scores were recorded pre-experiment and post-experiment. This allowed to have pre and post score for each group. This implies that independent variable of the study was group means under the condition they saw the video and heard voices, and dependent variable of the study was the total score (score calculated by summing pre-score and post-score). Meanwhile, the results of the experiment shows an absolute difference in the score of groups which is presented in table 2 below

Table 2 Descriptive Statistics

Table 2 presents descriptive statistics of the experiment data, and it is evident that mean score of the BB group is 11.75 with standard deviation of 8.421 which implies that on average score of each participants is 11.75 but the mean value could increase or decrease by the value of standard deviation. In same way, the mean value of group BB X NS is 7.60 with standard deviation of 6.107; whereas mean of NG and NS group is 10.50 (SD 7.506) and 11.60 (SD 7.829); this suggests standard deviation of each group is higher indicating that actual scores of each participants in each group is far away from the mean.

Inferential Statistics

In order to determine, the influence of box-breathing and nature sound on the cognitive functioning among Birkbeck College Masters Students. For this purpose, 2x2 ANOVA was used to determine the influence of four different conditions on cognitive functioning of the students; where the independent variable is defined as a group and the dependent variable is defined as total score. Table 3 presents the test of between-subjects effects, where it can be determined that R-squared is 0.064 that suggests that only 6.4% variance of the total score is explained by the model or the groups representing four different conditions BB, BBxNS, NB and NS. However, the adjusted R-square suggests that model may not fit with the data or is overfitting and may not capture the relavent factors influencing cognitive functioning of the students.

Table 3 Tests of Between-Subjects Effects

Furthermore, the results also suggests that group variable shows F (3, 14) = 0.321, p>0.05; this indicates that there is statistically insignificant impact of box-breathing and nature sound on the cognitive functioning of the students. Therefore, it can be stated that none of the condition play any role in influencing the cognitive functioning of the students. These findings are contradictory to the findings of Grillon, Quispe-Escudero, Mathur & Ernst (2015) and Manning, Bakhshaie, Shepherd, Jones, Timpano, Viana & Zvolensky (2019) where authors found that nature has positive effect on the psychological wellbeing of the students when they are exposed to nature. For instances, attention restoration theory (ART) explains this that cognitive fatigue is a result of stress of carrying out certain tasks for a long period of time, so exposure to natural environment could mitigate that stress and enhance the cognitive functioning of the students (Ohly, White, Wheeler, Bethel, Ukoumunne, Nikolaou & Garside, (2016). In this regards, the findings of Luo, Wang and Chen (2021) can also be presented where authors conducted an experiment on 71 students and exposed them to natural environment. The findings of the experiment revealed that positive effects were reported into the group of students who were exposed to natural environment, where psychological wellbeing, enhanced cognitive performance, improved attention and working memory was reported.

Table 4 presents the multiple comparison of the groups to see if the significant difference between the groups exists. The mean difference of each group is presented along with the standard error and sig value indicating if the difference is statistically significant or not. Meanwhile, referring to the sig value of all group comparisons is greater than 0.05 that indicates that there is no significant mean difference between the groups.

Table 4 Multiple Comparison

The post-hoc (Tuckey HSD) presented in table 4 reveals that there is no significant difference in the groups; suggesting that none of the group has statistically significant score to one another. This implies that cognitive functioning of the students did not improve even after box-breathing, nature sound, box-breathing along with nature sounds and just breathing normally. Therefore, the findings of the experiment could be concluded as that there is no influence of box-breathing and nature sound on the cognitive functioning among the Birkbeck College Masters Students.

Discussion 

Summary of Findings 

The analysis determined that Box-breathing and nature sound have a statistically negligible effect on the students' cognitive functioning. The cognitive functioning of students is not affected by box-breathing, blending with nature sounds, breathing in other forms, or breathing normally. According to the experiment, participants who were exposed to natural conditions reported enhanced cognitive performance and attention span and better working memory in their group. Moreover, it has also been determined that the group scores are not significantly different between them, indicating that none of them has a statistically significant score. 

Implications for Open Questions

The results from the ANOVA, indicate no significant differences, between the groups, contradicting the hypothesis, that participants would perform better, on cognitive function tests, after box-breathing, and nature sound conditions, especially in the combined condition. According to Attention Restoration Theory (ART), natural environments can restore cognitive function, by allowing the brain, to recover from mental fatigue (Liu et al., 2024). The lack of significant results suggests, that the combination of box-breathing, and nature sounds, may not have provided the expected restorative benefits, potentially due to the experimental conditions, the specific cognitive tasks used, or individual differences, among participants. In this manner, further research is needed to explore these factors.

Implications for theoretical and Empirical Background 

The study's findings, challenge the assumptions of Attention Restoration Theory (ART), which suggests, that exposure to natural environments, can restore depleted cognitive resources. Although ART posits, that natural stimuli like nature sounds, should enhance cognitive function, the absence of significant effects, in this study implies that the combination of box-breathing, and nature sounds, may not synergize as hypothesized. 

Limitations 

Several limitations might have influenced the study's outcomes. First, the small sample size reduces the statistical power, potentially obscuring significant effects. In addition, the study was conducted in a controlled laboratory setting, which may not fully replicate the natural environments, posited by ART. Moreover, the cognitive tasks selected, might not have been sensitive enough, in terms of detecting subtle improvements, in cognitive function. 

Future Research 

Future research should consider a larger sample size to increase statistical power and explore the effects of these interventions in more naturalistic settings. It would also be beneficial to examine the impact of varying the duration and intensity of both box-breathing and nature sound exposure. Additionally, research should account for individual differences, such as baseline stress levels and prior experience with mindfulness, to better understand the conditions under which these restorative techniques might be most effective. 

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