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Potential Impact of Breathing Practice on Brain and Mental Health in Rural Adolescents with Psychiatric Symptoms: study protocol for a single-arm pilot feasibility trial
Journal article   Open access   Peer reviewed

Potential Impact of Breathing Practice on Brain and Mental Health in Rural Adolescents with Psychiatric Symptoms: study protocol for a single-arm pilot feasibility trial

Pravesh Sharma, Kaylynn Imsande, Danielle Boos, Nick Bormann, Rowa Osman, Marin Nycklemoe, Seokbeen Lim, Stephan Arndt, Jana Kainerstorfer and Paul Min
JMIR research protocols
07/20/2026
DOI: 10.2196/91615
url
https://doi.org/10.2196/91615View
Published (Version of record) Open Access

Abstract

Background: Mental health conditions (MHC), in particular depression and anxiety are the leading contributors to youth disability globally. In the United States, there has been a steep increase in diagnosed MHC cases over the last decade. Adolescents in rural areas are often disproportionately affected due to a combination of limited access to mental health professionals, and stigma around seeking care. Untreated depression and anxiety can lead to an increased risk of substance use, academic struggles, and delinquency, making early intervention key to preventing such negative outcomes. Current treatment options, mainly psychotherapy and psychopharmacology, have shown modest effects. Prior research suggests associations between slow paced deep breathing and autonomic function, cerebral perfusion, and stress regulation, rendering structured breathing an under-utilized tool for MHC management. Objective: This project addresses two key priorities: reducing health disparities and enhancing population and value-based care in rural communities. This project is grounded in an equity-oriented approach to serving diverse and underserved youth populations by utilizing structured deep breathing, as an accessible and low-cost intervention. Methods: This study assesses the feasibility of collecting functional near-infrared spectroscopy (fNIRS) and data in the full sample and magnetic resonance imaging (MRI) in a subsample of 20 adolescents, without prespecifying neurobiological efficacy hypotheses. We aim to recruit approximately 40 adolescent patients receiving care through the Mayo Clinic Health System (MCHS) from rural communities in northwestern Wisconsin and southeastern Minnesota. All primary and secondary outcomes will be summarized using descriptive statistics, including means, standard deviations, medians, proportions, and 95% confidence intervals, as appropriate. Because this is a pilot feasibility study, the analytic focus is on estimation, variability, and data completeness, rather than hypothesis testing or formal statistical inference. Results: This study focuses on generating feasibility metrics and descriptive summaries of physiological and psychological data to inform future trial design. Conclusions: Adolescents with anxiety and depression are a particularly vulnerable group, often undertreated due to limited access to mental health care. The proposed breathing intervention offers an accessible and scalable tool that integrates multimodal brain physiology measures in rural youth populations.

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