Airways to Alteration: Investigating the Impact of Breathwork & Meditation on Conscious State
Phase: NA
Conditions: Altered States of Consciousness, Wellbeing
Sponsor: University of Sussex

Protocol & SAP 
 
Airways to Alteration (A2A): Investigating the Impact of Breathwork & 
Meditation on Conscious State (NCT06916312) 
 
Comparing Effects of Intense Breathwork to Meditation on Altered States of 
Consciousness (A2A) 
 
Summary 
This study aims to investigate the impact of high ventilation breathwork (HVB) and 
meditation on altered states of consciousness (ASCs). The study will compare the 
effects of a single guided HVB session to a single guided body scan meditation session. 
The primary aim is to explore the impact of HVB and meditation on ASCs, while 
secondary aims relate to mental health and wellbeing. 
 
Guy William Fincham 
 
Original document date: May 21, 2025 
Edited document data: June 09, 2025 
Reason for edit: Had EBI listed as secondary outcome measure (incorrect) in the Protocol instead of a 
primary outcome measure (correct) as per the pre-registration NCT06916312. 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 

Abstract 
Breathing is fundamental to life, rooted in the Latin word "spiritus," meaning spirit or life force. 
Through this project, we aim to explore the impact of high ventilation breathwork (HVB), a 
practice that uses deliberate, intensified breathing to create altered states of consciousness 
(ASCs). These states have been described as lived experiences that expand perception, foster 
a sense of connection, and bring deep personal insights. While substances like psychedelics 
are known to induce ASCs, they are often restricted due to costs, legal limitations, and health 
concerns. HVB, however, offers an accessible, drug-free way to reach similar states. Early 
research even suggests that HVB can lead to experiences comparable to those produced by 
medium-to-high doses of certain psychedelics, like psilocybin. Yet, unlike meditation or other 
therapeutic practices, HVB has not been rigorously studied in clinical trials. Our study plans to 
take an important first step by conducting a randomised controlled trial (RCT) on the effects of 
a single guided HVB session. This will involve experienced breathwork practitioners and will 
assess a range of outcomes, including ASCs, mystical experiences, emotional breakthroughs, 
and overall mental wellbeing. To help us understand the unique effects of HVB, we will also 
have a comparison group, where participants will engage in a meditation session led by the 
same facilitator. Essentially, we will be comparing a single guided session of HVB (intervention) 
to a single guided session of body scan meditation (active comparator). Then, using the Altered 
States Database, an open-science project based on systematic literature reviews, we can 
compare to prior data on altered state-induction methods like meditation and psychedelics. 
The primary aim is the impact of HVB and meditation on ASCs. Secondary aims relate to mental 
health and wellbeing. For the first time we will also examine the relationship between 
predictiveness of the psychedelic experiences emerging from HVB and meditation. By 
conducting this study, we hope to create a foundation for future clinical research and build 
evidence on HVB's potential as a therapeutic tool. This project responds to the growing interest 
in non-drug methods for achieving profound mental and emotional states—showing that the 
key to these transformative experiences may be as close as our own breath. 
 
Introduction 
High ventilation breathwork (HVB), mind-body practices which increase respiratory rate and/or 
depth, has been used to relieve various forms of psychological distress for millennia. Recently 
HVB has started receiving an unprecedented surge in public interest owing to its potential to 
induce altered states of consciousness (ASCs) and improve mental/physical health. 
Psychoactive substances represent one way to evoke ASCs but unquestionably not the only 
one [1]. Whilst there has been an explosion in psychedelic research in the West, ancient 
cultures across the globe have used physical challenges to evoke ASCs in ceremonial settings, 
i.e., extreme temperatures, fasting and sleep deprivation. However, arguably the most 
accessible of which is HVB—techniques that are observed worldwide and have complex 
historical roots grounded in both religious and secular traditions [2]. Such practices have been 
used since time immemorial for spiritual and healing purposes, being frequently described in 
the rituals of many cultures [2]. We aim to meticulously explore the phenomenological effects 
of HVB. With thoughtfully curated set and setting, HVB has been reported to elicit profound 
mystical experiences and ASCs akin to those evoked by psychedelics [1,3], including medium 
to high doses of psilocybin [4]. Current research on ASCs has predominantly focused on 
pharmacological methods, however there is a growing interest in nonpharmacological 
approaches, which are often more accessible and culturally acceptable. This also removes 
medical, legal and financial barriers [1]. 

Our Lab has started characterising phenomenological and neurophysiological effects 
of HVB to inform its mechanism of therapeutic action, safety profile and future application. 
Clinical observations and data from neurophysiological studies indicate that HVB is associated 
with extraordinary changes in subjective experience, and profound effects on central and 
autonomic nervous systems functions through modulation of neurometabolic parameters and 
interoceptive sensory systems [2]. Nondrug alternatives for eliciting and working with ASCs are 
needed, as many individuals wish to derive therapeutic benefit via experiencing psychedelics’ 
effects without the need to ingest substances. Breathing provides a potential resource that we 
have at our disposal (here and now) for improving wellbeing, and its consciousness expanding 
effects can be stopped at any point by simply returning to a normal cadence. With HVB we are 
not solely relying on an external source in the form of a drug compound, but our own innate 
inner capacity for healing. However, like psychedelics, as HVB becomes increasingly popular, 
it is extremely important that the hype is grounded in—and calibrated with—robust research 
evidence. This translates to rigorous clinical testing. 
The study is a randomised controlled trial (RCT) involving up to 24 healthy adult 
participants who have prior experience with HVB. Participants will be randomly allocated to 
either the HVB or meditation group. The study will assess outcomes such as ASCs, mystical 
experiences, emotional breakthroughs, psychological insight, and overall wellbeing. 
 
Motivation 
Despite ancient and modern use paired with countless anecdotal evidence of its profound 
effects, empirical research on HVB is limited [2]. No published study has yet examined the 
effects of HVB on ASCs through an RCT. To put the ASC field in perspective, only data from one 
published HVB study [3] are currently listed on the Altered States Database* [5] (an open-
science project based on systematic literature reviews) for an established psychological 
measure of ASCs, in comparison to 40 and 44 entries on psilocybin and LSD, respectively. 
Moreover, there are no published data on HVB for an established psychological measure of 
mystical experiences on the Altered States Database, but there are 33 and 23 entries for 
psilocybin and LSD, respectively. Most breathwork research at present has been on slow-
paced techniques [6,7], however the field of HVB is currently in its infancy [2,8]. 
 
*The database is powered by the Collaboration for Interdisciplinary Research on Conscious 
Experiences (CIRCE). 
 
Impact/Significance 
Such (breath)work has the potential of helping pioneer a new therapeutic modality in the form 
of the breath, a tool which can be accessed by anyone instantaneously. This may pave the way 
for larger, robust RCTs on HVB to occur. In doing so, at a societal level, we could help establish 
HVB as an accessible, low-cost nondrug alternative for expanding global consciousness. 
Large-scale robust clinical testing is a necessary step for the evolution of HVB if it is to be 
integrated into healthcare systems across the world. The perturbed psychophysiological state 
induced by HVB may also have broader applications regarding how it can be harnessed in a 
therapeutic context. Deeper knowledge of the ASCs induced by HVB—through rigorous testing 
of its effects—may deliver societal benefit, in a time where raising global consciousness is 
needed most. This research represents a step to doing just that. 
 
 

Research Aims/Questions 
Principal research questions/objectives include: 1. Investigate potential differences in ASCs 
induced by a single session of HVB—in particular Conscious Connected Breathing (CCB)—
versus a body scan meditation. 2. Examine whether HVB (CCB) induces ASCs comparable to 
psychedelics (via the Altered States Database, an open-science project based on systematic 
literature reviews). 3. Investigate potential differences on mental health and wellbeing after 
HVB or a body scan meditation. 4. Examine correlation between ASCs and changes on mental 
health and wellbeing, in addition to the relationship between preparedness/predictiveness of 
participants to experience psychedelic effects and ASCs. 
 
Materials/Methods 
Unlike slow breathwork, high ventilation breathwork (HVB) has not been exposed to the same 
level of robust clinical testing to date [2,6-8], a necessary step to realise its potential 
application as a therapeutic modality. We will conduct the first randomised-controlled trial 
(RCT) of HVB on altered states of consciousness (ASCs). This will take the form of a small pilot 
study wherein participants are randomised to in-person, guided HVB or a meditation group. 
 
Study type 
This will be an experimental study, where participants are randomly assigned to a HVB 
intervention or body scan meditation. This will be a small-scale pilot RCT, hopefully leading to 
a large-scale clinical trial in the future (depending on funding). 
 
Data collection procedures 
Quantitative data: The primary outcomes will be ASCs as measured by the Five Dimension ASC 
Rating Scale (5D-ASC) [9], the short Mystical Experience Questionnaire (MEQ) [10], and 
Emotional Breakthrough Inventory (EBI) [11]. 
Secondary outcomes include: the Psychological Insight Questionnaire (PIQ) [12], 
Depression Anxiety Stress Scales (DASS) [13], Short Warwick-Edinburgh Mental Wellbeing 
Scale (SWEMWBS) [14], Imperial Psychedelic Predictor Scale (IPPS) [15], PROMIS Sleep-
Related Impairment Scale (PROMIS-4a) [16], Shortened Fatigue Questionnaire (SFQ) [17], and 
Cambridge Depersonalisation Scale-State Version (CDSS) [18]. 
There will also be optional open-ended responses on overall experience of the 
meditation or breathwork. The following state measures will be completed immediately after 
the HVB and meditation sessions: 5D-ASC, MEQ, EBI and CDSS. The following trait measures 
will be completed 7-10 days before and 7-10 days after the breathwork  and meditation 
sessions: DASS, SWEMWBS, PROMIS and SFQ. The IPPS will be completed when subjects 
consent to participating, and the PIQ will be completed 7-10 days after the breathwork and 
meditation sessions. 
Qualitative data: Optional open-ended responses will capture participants’ lived 
experiences after the breathwork and meditation sessions. 
 
Sample 
Given this is a small pilot study, 24 participants (12 per group) will be recruited. The studies of 
Bahi et al. (2023) and Havenith et al. (2024) report HVB having comparable effects on ASCs to 
moderate-high doses of psilocybin, which has large-very large effect sizes on ASCs. This is an 
ethical number of participants for a single session HVB intervention with two breathwork 
facilitators present. It is ideal to have no more than six breathworkers per facilitator. 

Accordingly, there will be two groups of 12 for our study (12 in the HVB group, and 12 in the 
meditation group). At 80% power with an alpha of 0.05, based on Havenith et al.'s HVB study's 
between-groups effect size (1.29) on the self-completion depressive symptomology survey, a 
sample size of 22 is needed, allowing room for potential attrition. Effect sizes reported by Bahi 
et al. were greater, but this was a within-groups design. 
Participants will be recruited from the local area using advertisements online (social 
media/email) via the PI and (co)facilitators' networks. It will be incumbent upon those people 
interested in taking part to contact the PI. Participants will be comprehensively screened and 
the inclusion criteria will be adults with experience of HVB, living in Brighton (UK) and the 
surrounding area. Given the nature of HVB, the comprehensive eligibility criteria are as follows: 
Inclusion Criteria: Healthy adults (18-65) in Brighton and the surrounding area; Prior 
experience practising high ventilation breathwork in the form of conscious connected 
breathing; No history of adverse events during such prior breathwork sessions. Exclusion 
Criteria: History of hypotension; Hypertension; Respiratory or cardiovascular problems; 
Fainting or syncope; Epilepsy or seizures; Panic disorder or panic attacks; Cerebral aneurysm; 
Pregnancy (and possibility one might be pregnant, trying to get pregnant, or are breastfeeding); 
Breathlessness; Bradypnea; Tachypnoea; Any mental/physical issues affecting the ability to 
engage in breath control activities. 
 
Procedure 
Prospective participants will be emailed an Information Sheet—and they will be given as long 
as needed to decide if they wish to participate. A Consent Form will be completed prior to any 
study related procedure. The informed consent process will include aims, rationale, methods 
and potential adverse effects of the study and will be followed by the completion of the Consent 
Form. The participant will be allowed as much time as they wish to consider the information, 
and the opportunity to question the PI, their GP, or any other independent parties to decide 
whether they will participate in the study. The PI taking consent will explain to the potential 
participants that they are free to refuse any involvement within the study or alternatively 
withdraw their consent at any point during the study—for any reason. The informed consent of 
the participant will be recorded and retained using an online form, with a copy of the signed 
Consent Form of which they can keep. No study procedure will be carried out until informed 
consent has been obtained from the participant. 
Participants will be able to withdraw from the study at any time, and for any reason, 
without having to provide any explanation for their decision. Participants will be told that they 
can withdraw from the study at any time. If they request it, their data can be removed from the 
database. The deadline for the withdrawal of their data will be at the time of completion of data 
analysis. We expect this to be around 3 months after the session.  
Participants will be briefly screened for eligibility prior to taking part into the study. They 
will be randomly allocated to HVB or meditation groups using block randomisation (1:1), 
stratified by scores on the brief 9-item Imperial Psychedelic Predictor Scale (IPPS), which will 
be completed shortly after the Consent Form has been signed. Short self-completion 
questionnaires will be administered to participants ~1 week pre and post the HVB or body scan 
meditation, along with once immediately after the HVB and meditation. The platform used for 
questionnaires will be Qualtrics and, where visual analogue scales are used, will contain a 
scale with 0 (%) on the left and 100 (%) on the right. The single sessions of breathwork and 
meditation will take place at Little Dippers in Brighton, a naturalistic setting where the facilitator 
regularly teaches HVB. 

Participants will be compensated 5GBP, 10GBP and 15GBP (money) per questionnaire 
completed (30GBP total but in a phased manner to increase retention). Moreover, participants, 
regardless of group, will be participating in an active intervention (HVB or body scan meditation) 
which will be provided free of charge. 
 
Processing and Analysis Plan 
Results will be analysed using the software programme R. The outcome measures collected 
on the day of the HVB or meditation will be analysed using simple quantitative analyses (i.e., 
unpaired t-test or Mann-Whitney U-test depending on distribution of the data), whilst the 
outcomes ~1-week pre-post will be analysed using repeated-measure analysis of variance 
(ANOVA) or Friedman's test depending on distribution of the data. Changes on the mental 
health and wellbeing measures will be correlated with scores on the ASC measures. Simple 
qualitative content analysis will be used to analyse any responses to open-ended questions of 
participants' experience of the HVB or meditation. 
 
Ethical considerations 
The Brighton and Sussex Medical School Research Governance and Ethics Committee (RGEC) 
has assessed this project and granted Ethical and Research Governance Approval to proceed 
(Reference Number: ERA/GF221/9/1). 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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