It almost goes without saying that we have a tremendous amount of stress in our society and the world right now. As Kurhaluk et al. (2025) point out, we are still dealing with the consequences of the COVID 19 pandemic, "climate-related uncertainty," economic and social inequality, and more. Bateson et al. (2025) report that rising costs of living and food insecurity cause increasing symptoms of anxiety and depression. Stress worsens any ongoing inflammation, which in turn worsens mood symptoms, sleep problems, cognitive fuzziness, and especially pain. The neuroimmune dysregulation consequent to chronic stress impacts not just the brain, but most other tissues, especially the gut, immune system, heart, and liver (Feng 2025). But in the US, access to healthcare to manage health consequences of stress is getting harder, and patchy access to healthcare is one of the motivations for people to use "supplements" such as the substance called kratom (more on that in News and Views).
I feel like I'm a typical example of how societal stress affects inflammation. 2025 was a painful year for me. I have an auto-inflammatory, possibly autoimmune condition called "inflammatory back." It was initially triggered nearly twenty years ago by throwing my neck out reading a book. Don't laugh. This happens to people more often than you might think. Normally the effects of throwing your neck out reading a book resolve with anti-inflammatory medication and physical therapy. But it did not for me. I was left with significant residual pain and impaired range of movement in my arms. Fortunately for me, after a few years I had the opportunity to take a Restorative Yoga teacher training class. I was not actually taking the class to help myself (I didn't really believe I could get better), but I discovered that one of the yoga positions lessened my pain considerably. I also found that if I maintained this position for at least 60 minutes while controlling my breathing, 3–4 hours later my pain would go away. This effect was sudden and lasted for the rest of the day.
I was not really surprised by these beneficial effects. Relaxation and controlled breathing, which are key for restorative yoga and other yoga practices such as Iyengar, can activate the parasympathetic nervous system, particularly the vagus nerve. In the late 1990s/early 2000s it was demonstrated that stimulation of the vagus, via its neurotransmitter acetylcholine, can directly down-regulate inflammation by interacting with inflammatory immune cells. This effect is called the vagal cholinergic anti-inflammatory pathway. This pathway can directly reduce inflammation in the places it innervates (airways, heart, gut, possibly kidneys, bladder, and reproductive organs) as well as other sites of inflammation via influence on systemic immune cells.
You may have heard of electrical "Vagus Nerve Stimulation" (VNS). It was initially shown to improve seizure frequency in epilepsy, and has since been successfully used to treat treatment-resistant depression, headaches, fibromyalgia, inflammatory bowel disease, obesity, and rheumatoid arthritis (Austelle 2024; Di Assis 2026; Liu 2025; Yapp 2020). The original form of Vagus Nerve Stimulation is done by implanting a device in the chest wall that provides electricity to electrodes that are wrapped around the cervical vagus nerve. Since this is surgery, it carries risk of infection and irritation of the tissue around the nerve. There other side-effects reported, including problems with vocal cords and negative effects on sleep (Austelle 2024).
Because of these risks, non-invasive stimulators have been developed that use transcutaneous electrical stimulation. There are two types of these, with one kind stimulating the cervical vagus (front of the neck), and the other type stimulating the auricular branch of the vagus on the earlobe (Austelle 2024; Yapp 2020). In general, the noninvasive type of vagal stimulation is somewhat less effective (De Assis 2026), but one device (from gammaCore) is approved and marketed for headaches and can be purchased with a prescription. Unfortunately, the device is only good for a set number of uses, so this treatment can get pricey if you need more than that.
In 2013 I had the opportunity to take a very sweet Mindfulness Based Stress Reduction course. For this course our homework was doing daily meditations of at least 15 minutes duration. I preferred doing breathing meditation (with controlled breathing) more than the other kinds presented. After doing 10 weeks of daily breathing meditations, I did get a surprise. Suddenly not only was my pain gone but I had recovered normal range of motion. Wow! I have been using breathing meditation since then to control pain and inflammation. It's great because I can do it every day if I need to, and it is free and has no side-effects (other than lowering blood pressure). Eventually, though, I "got busy," felt well, and let my daily meditation practice lapse.
Then fast-forward to 2025. I had two serious back attacks that needed steroids to get under control. Previously I had only two such serious back attacks in more than 15 years. I still had residual pain and stiffness. Although ibuprofen helped, you can't take that every day. So, I went back to my daily meditation practice, which got everything under control. I'm not letting it lapse again, so I have integrated the meditations into my "morning ablutions."
I'm sharing my story because I see a huge need for safe, effective, and affordable approaches to the physical and emotional suffering I see and hear about around me. Whereas in the research world, there are people talking about implementing mind-body practice to address stress, I'm not seeing that people realize how powerful they can be. And most discussion and enthusiasm concerns drugs and devices that are expensive and not accessible to the people who may need them most.
Among the studies that I have seen over the years, most of the results have not been as dramatic as mine. One exception is the ability of implanted stimulator-induced VNS on fibromyalgia (a stress-sensitive inflammatory condition), in which some participants were in remission after the treatment. What might account for this discrepancy? I suspect there are a few main reasons. For one thing, most studies that use daily practice were shorter term (usually 28 days or so) than the 10 weeks of diligent daily meditation I did. In my experience, the regular practice is key.
Reading the method sections of papers, I have also noticed that relaxation is not always a part of the breathing protocol. For me, combining the "relaxation response" (the parasympathetic opposite of the sympathetic "fight or flight response") with controlled breathing seems to be a key part of the meditation experience. In support of this, a recent paper (Pathan et al. 2023) reported that combining relaxation with deep breathing for patients with primary hypertension delivered larger effects on blood pressure, heart rate, and anxiety compared to controls than either technique alone. The two techniques seem synergistic.
Another factor may relate to the fact that there are many different specific types of breath work. Some techniques may be more effective for activating the vagus. For instance, a study by Bilban (2023) reported that a breathing technique called "cyclic sighing" was most effective compared to two other types of breath work and mindful observation of breathing when assessing indicators of anxiety. More on this paper can be found under Journal Club.
Explanations for different effects could be related to the effects of different breathing techniques on phases of the respiratory cycle, which have different on the sympathetic and parasympathetic systems (Bilban, 2023). Also, the "deepness" of the breath is likely important, because vagal sensory neurons that innervate airways and activate the anti-inflammatory reflex are "stretch receptors" (Mann-Nüttel 2025). These are likely to be most activated by breaths that stretch the airways open and put pressure on the airway walls.
In support of this, I have found that the best way for me to get my vagus going is a technique called "ujjayi breathing" (also known as "breath of victory," "ocean breath," or "Darth Vader breathing"). To do it I just draw my breath in, and out, hard against my throat, and it makes a noise, maybe like the ocean or Darth Vader? I don't try to "constrict my throat" or anything, I don't seem to need to. This type of breathing does lead to deep inhales, and I do it for both inhale and exhale. It can be combined with other breathing techniques such as "abdominal breathing." It's easy and works great. I can tell when it is working because my heart slows down, becomes softer in the way that its beating sounds, and the rhythm becomes regular. Also, on the exhale, my mouth fills up with very clear saliva, a vagal afferent-induced parasympathetic reflex effect on salivary glands (Ueda 2016). You also sometimes hear "gut noises" which also signal vagal activation. This might read like "TMI," but it can be nice to have some confirmation that the practice is having an effect.
Stress-induced anxiety and depression can also benefit from vagus nerve stimulation. Whatever way you stimulate the vagus, you can take advantage of "bottom-up" vagus nerve/breathing effects that include mitigating anxiety, depression, cognition, and neuroinflammation (e.g., Maric 2020; Mann-Nüttel 2025). The sensory fibers of the vagus nerve, especially those innervating airways, can down-regulate stress responses and hyper-arousal that are characteristic of anxiety and sleep problems (Maric 2020). This means that modalities that can activate the vagus can treat both the psychological/neurological and the inflammatory consequences of stress.
It is now clear that vagal stimulation can be a powerful approach to managing a wide variety of neurological and immunological conditions. Although the bulk of the research revealing this has used electrical stimulation, there is now enough evidence to support the idea that "natural" vagal stimulation via controlled breathing techniques can be just as effective (Balban 2023; Gamboa 2025; Gerbarg 2015; Zou 2017). One example is from Balint et al. (2022), where they used controlled breathing to activate the vagus and successfully reduce inflammation in COVID-19 patients.
Overall, I think relaxing breathing meditation could be a very helpful "tool in the toolbox" for many people who are suffering from the consequences of stress and inflammation, but are not receiving adequate help.