PauseDeck
About the Practices
Here you’ll find the research, clinical guides, and established exercises that inform PauseDeck.
These sources explain the background of the practices. They do not mean that every card, timing, or instruction has been tested individually.
PauseDeck is a self-guided wellbeing tool, not therapy or medical treatment.
Breathing
Our breathing cards draw on research into slow breathing and structured breathing practices, including cyclic sighing and box breathing.
Research
Balban, M. Y., et al. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1), 100895.
A randomized trial compared five minutes of daily breathing exercises with mindfulness meditation over one month. Breathwork, particularly cyclic sighing, showed greater improvement in positive mood and reduction in breathing rate. The study did not test PauseDeck’s three-breath version.
Zaccaro, A., et al. (2018). How breath-control can change your life: A systematic review on psycho-physiological correlates of slow breathing. Frontiers in Human Neuroscience, 12, 353.
Reviews links between slow breathing, physiological changes, and psychological outcomes in healthy participants. The included techniques and study methods varied.
Noticing your surroundings
Sensory grounding means bringing your attention to what you can see, hear, touch, smell, or taste, and to your contact with the world around you.
Practical guides
World Health Organization. (2020). Doing what matters in times of stress: An illustrated guide.
Read the guide and access accompanying exercises
An evidence-informed, field-tested guide covering grounding, unhooking from difficult thoughts, and other ways of responding to stress.
NHS inform. (n.d.). Grounding exercises.
Practical guidance on sensory grounding, including the familiar 5–4–3–2–1 exercise.
Tensing and releasing muscles
The squeeze-and-release cards draw on progressive muscle relaxation, which involves noticing the difference between muscle tension and release.
Research
Muhammad Khir, S., et al. (2024). Efficacy of progressive muscle relaxation in adults for stress, anxiety, and depression: A systematic review. Psychology Research and Behavior Management, 17, 345–365.
Reviews 46 publications involving more than 3,400 adults. Findings generally favor progressive muscle relaxation for stress and anxiety. These programs are usually more extensive than a single hand or shoulder release.
Making room for thoughts and feelings
Several cards draw on Acceptance and Commitment Therapy (ACT). One practice is called cognitive defusion: noticing a thought as a thought, so you have more choice in how you respond.
The thought-prefix card and the leaf visualization use established ACT exercises. PauseDeck does not claim to have invented these practices.
Practice background
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.
A foundational clinical text on psychological flexibility, acceptance, and cognitive defusion.
Harris, R. (2015). Function versus form in thoughts.
Describes the established defusion practice of adding a thought-labeling phrase before a difficult thought.
Harris, R. (n.d.). Leaves on a stream. Psychwire.
An example of the ACT exercise in which thoughts are imagined on leaves moving along a stream.
Responding to worry
Other cards invite you to examine a prediction, consider another possibility, or set aside a specific time to return to a worry.
Clinical background and practical guidance
Clark, D. A., & Beck, A. T. (2010). Cognitive therapy of anxiety disorders: Science and practice. Guilford Press.
A clinical text explaining cognitive models of anxiety and ways of working with anxious interpretations and predictions.
Centre for Clinical Interventions. (n.d.). Worry and rumination: Information sheets and workbooks. Government of Western Australia.
Includes practical resources on postponing worry, attention training, problem-solving, and helpful thinking.
Kindness and comforting touch
Some cards invite you to speak to yourself as you would to a friend, or to notice the contact of a hand resting on your body.
Practical guidance
Self-Compassion Institute. (n.d.). Exercise 1: How would you treat a friend?
A self-compassion exercise from Kristin Neff’s resource collection, exploring how to offer yourself the kindness you would offer a friend.
Research
Dreisoerner, A., et al. (2021). Self-soothing touch and being hugged reduce cortisol responses to stress: A randomized controlled trial on stress, physical touch, and social identity. Comprehensive Psychoneuroendocrinology, 8, 100091.
In a laboratory study of 159 healthy adults, self-soothing touch and receiving a hug reduced cortisol responses compared with control conditions. Heart rate and reported stress did not differ between conditions.
Music and sound
A familiar song can provide something concrete to listen to and take part in. Music research offers background for this part of the deck.
Research
de Witte, M., Spruit, A., van Hooren, S., Moonen, X., & Stams, G.-J. (2020). Effects of music interventions on stress-related outcomes: A systematic review and two meta-analyses. Health Psychology Review, 14(2), 294–324.
A review of 104 randomized trials found overall benefits for physiological and psychological measures of stress. The interventions varied; it does not establish that five humming breaths produce the same effects.
Alternating taps
The crossed-arm tapping card draws on the butterfly hug, a self-administered alternating-tap method used in EMDR-related clinical practice. A brief tapping card is not a course of EMDR therapy.
Practice background
EMDR International Association. (n.d.). The EMDR therapy butterfly hug method for self-administered bilateral stimulation. Resource listing for an article by Ignacio Jarero and Lucina Artigas.
Identifies the clinical method behind this style of tapping and provides further reading.
Further reading
These sources provide broader theory and clinical context. They are not trials of individual PauseDeck cards.
Gerritsen, R. J. S., & Band, G. P. H. (2018). Breath of life: The respiratory vagal stimulation model of contemplative activity. Frontiers in Human Neuroscience, 12, 397.
A theoretical review proposing how breathing may contribute to the effects of contemplative practices.
Levine, P. A. (2010). In an unspoken voice: How the body releases trauma and restores goodness. North Atlantic Books.
Clinical and theoretical background on body-oriented approaches to trauma.
Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. W. W. Norton & Company.
Clinical background on body awareness, orienting, and sensorimotor psychotherapy.
Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (3rd ed.). Guilford Press.
Background on the full EMDR therapy approach.
The linked authors and organizations are independent of PauseDeck. References acknowledge the background of the practices and do not imply endorsement of the app.