(PS5-D84) Efficacy of Daily Breathing Exercise on Alcohol Craving, Stress, and Anxiety Delivered via Smartphone Application

Introduction:
Stress is a risk factor for problematic drinking and relapse after treatment in alcohol use disorder (AUD).  Breathing exercises are known to be beneficial for stress reduction but the benefit in AUD has not been studied. The current study tested the utility of a breathing app as a digital intervention aide to promote self-guided breathing skills in outpatient settings for (1) individuals with alcohol use disorder and (2) risky drinkers.

Method: A specifically designed daily breathing app was used in the context of two outpatient interventions that integrate standard behavioral alcohol treatment with a breathing-based stress reduction program (two sessions per week). In study 1, 23 individuals with AUD (mean age= 30.5 years, 12 women) underwent 8-week outpatient treatment. In study 2, 6 individuals (mean age=32.5 years, 3 women) with risky drinking patterns based on NIAAA guidelines underwent a 4-week alcohol prevention program. Throughout the intervention periods, participants used a daily breathing app to practice techniques consisting of resonance breathing, deep breathing, and self-guided breathing while listening to relaxing audiotapes (15 mins total). Before and after each breathing exercise, participants rated their levels of affect, alcohol craving, stress, anxiety, arousal, attention, fatigue, and pain.

Results: We analyzed the efficacy of the self-guided daily breathing app using multilevel models. The fixed effects included Time (intervention day), Intervention (before, after), and Time X Intervention interaction. The random effects included random intercept and slope varying by subject. AUD individuals showed significant reductions in anxiety, stress, craving (ps< .001), arousal (p=.003), and improvements in attention levels (p< .05) and positive affect (p < .001) after the daily exercises. Significant Time X Intervention interactions on anxiety (p< 0.05) and stress (p=0.015) indicated that reductions in anxiety and stress due to daily breathing are accompanied by a decline of baseline levels of anxiety and stress for AUD individuals during the 8-week period. Risky drinkers showed immediate reductions in stress levels (p< 0.001) and alcohol craving (p< 0.05) as well as improved positive affect (p< 0.001) after the daily exercise. There were reductions in overall levels of stress (p< 0.001), arousal (p< 0.05), alcohol craving (p< 0.05), fatigue (p< 0.001), as well as improved attention (p< 0.01) and positive affect (p< 0.001) during the 4-week period.

Contributions: The current study provides preliminary evidence supporting the effectiveness of a specific daily breathing app when added to standard behavioral counseling for alcohol misuse and AUD. The daily breathing app promoted immediate reductions in stress, anxiety, and alcohol craving and enhanced positive affect in both AUD individuals and risky drinkers. Use of the daily breathing app significantly reduced baseline levels of stress and anxiety throughout the intervention period. These findings support further development of daily breathing apps to promote self-guided breathing exercise as a cost-effective, readily available treatment aide for alcohol prevention and treatment programs (NIH grant support: R01AA026844; R01AA013892).