Validating the Breathing Vigilance Questionnaire for use in Dysfunctional Breathing.

Dysfunctional breathing (DB) is common among people with and without primary respiratory pathology. While anxiety can contribute to DB, the underpinning mechanism is unclear. One explanation is that anxiety induces conscious, vigilant monitoring of breathing, disrupting 'automatic' breathing mechanics. We validated a new tool that quantifies such breathing-related 'vigilance': the Breathing Vigilance Questionnaire (Breathe-VQ).Three-hundred-and-forty healthy adults (M age =27.3 years, range: 18-71; 161 men) were recruited online. We developed an initial Breathe-VQ (11 items, 1-5 Likert scale) based on the Pain Vigilance and Awareness Scale, using feedback from the target population and clinicians. At baseline, participants completed the Breathe-VQ, Nijmegen Questionnaire (NQ), State-Trait Anxiety Inventory (form 2), and Movement-Specific Reinvestment Scale (assessing general conscious processing). Eighty-three people repeated the Breathe-VQ two weeks later.Five items were removed based on item-level analysis. The resulting six-item Breathe-VQ questionnaire (score range: 6-30) has excellent internal (alpha=.892) and test-retest reliability (ICC=.810), a minimal detectable change of 6.5, and no floor/ceiling effects. Validity was evidenced by significant positive correlations with trait anxiety and conscious processing scores ( r 's=.35-0.46). Participants at high-risk of having DB (NQ>23; N=76) had significantly higher Breathe-VQ score (M=19.1±5.0) than low-risk peers (N=225; M=13.8±5.4; p <0.001). In this 'high-risk' group, Breathe-VQ and NQ-scores were significantly associated (p=.005), even when controlling for risk factors ( e.g. , trait anxiety).The Breathe-VQ is a valid and reliable tool to measure breathing vigilance. High breathing vigilance may contribute to DB, and could represent a therapeutic target. Further research is warranted to test the Breathe-VQ's prognostic value, and assess intervention effects.