A Multisite Benchmarking Trial of Capnometry Guided Respiratory Intervention for Panic Disorder in Naturalistic Treatment Settings

David F Tolin, Patrick B McGrath, Lisa R Hale, Daniel N Weiner, Ralitza Gueorguieva, David F Tolin, Patrick B McGrath, Lisa R Hale, Daniel N Weiner, Ralitza Gueorguieva

Abstract

Panic disorder (PD) is associated with hyperventilation. The efficacy of a brief respiratory feedback program for PD has been established. The aim of the present study was to expand these results by testing a similar program with more clinically representative patients and settings. Sixty-nine adults with PD received 4 weeks of Capnometry Guided Respiratory Intervention (CGRI) using Freespira, which provides feedback of end-tidal CO2 (PETCO2) and respiration rate (RR), in four non-academic clinical settings. This intervention is delivered via home use following initial training by a clinician and provides remote monitoring of client adherence and progress by the clinician. Outcomes were assessed post-treatment and at 2- and 12-month follow-up. CGRI was associated with an intent-to-treat response rate of 83% and a remission rate of 54%, and large decreases in panic severity. Similar decreases were found in functional impairment and in global illness severity. Gains were largely sustained at follow-up. PETCO2 moved from the slightly hypocapnic range to the normocapnic range. Benchmarking analyses against a previously-published controlled trial showed very similar outcomes, despite substantial differences in sample composition and treatment settings. The present study confirms prior clinical results and lends further support to the viability of CGRI in the treatment of PD.

Keywords: Biofeedback; Breathing; Freespira; Hyperventilation; Panic disorder; Respiration.

Conflict of interest statement

Conflict of interest

Dr. Tolin has received research grants from PAHS and Organon/Merck. Dr. Hale has received research grants from PAHS. Dr. McGrath has received research grants from PAHS. Dr. Weiner has received research grants from PAHS. Dr. Gueorguieva has received consulting fees from PAHS for statistical analysis.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
Diagram of participant flow. LTFU—lost to follow-up

References

    1. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Archives of General Psychiatry. 1961;4:53–63. doi: 10.1001/archpsyc.1961.01710120031004.
    1. Chambless DL, Caputo GC, Jasin SE, Gracely EJ, Williams C. The mobility Inventory for Agoraphobia. Behaviour Research and Therapy. 1985;23(1):35–44. doi: 10.1016/0005-7967(85)90140-8.
    1. Furukawa TA, Shear MK, Barlow DH, Gorman JM, Woods SW, Money R, Leucht S. Evidence-based guidelines for interpretation of the Panic Disorder Severity Scale. Depression and Anxiety. 2009;26(10):922–929. doi: 10.1002/da.20532.
    1. Guy W. Assessment manual for psychopharmacology. Washington, DC: U.S. Government Printing Office; 1976.
    1. Klein DF. False suffocation alarms, spontaneous panics, and related conditions. An integrative hypothesis. Archives of General Psychiatry. 1993;50(4):306–317. doi: 10.1001/archpsyc.1993.01820160076009.
    1. Leon AC, Shear MK, Portera L, Klerman GL. Assessing impairment in patients with panic disorder: The Sheehan Disability Scale. Social Psychiatry and Psychiatric Epidemiology. 1992;27:78–82. doi: 10.1007/BF00788510.
    1. Ley R. Blood, breath, and fears: A hyperventilation theory of panic attacks and agoraphobia. Clinical Psychology Review. 1985;5(4):271–285. doi: 10.1016/0272-7358(85)90008-X.
    1. Meuret AE, Rosenfield D, Hofmann SG, Suvak MK, Roth WT. Changes in respiration mediate changes in fear of bodily sensations in panic disorder. Journal of Psychiatric Research. 2009;43(6):634–641. doi: 10.1016/j.jpsychires.2008.08.003.
    1. Meuret AE, Rosenfield D, Seidel A, Bhaskara L, Hofmann SG. Respiratory and cognitive mediators of treatment change in panic disorder: evidence for intervention specificity. Journal of Consulting and Clinical Psychology. 2010;78(5):691–704. doi: 10.1037/a0019552.
    1. Meuret AE, Wilhelm FH, Ritz T, Roth WT. Feedback of end-tidal pCO2 as a therapeutic approach for panic disorder. Journal of Psychiatric Research. 2008;42(7):560–568. doi: 10.1016/j.jpsychires.2007.06.005.
    1. Pollack MH, Simon NM, Worthington JJ, Doyle AL, Peters P, Toshkov F, Otto MW. Combined paroxetine and clonazepam treatment strategies compared to paroxetine monotherapy for panic disorder. Journal of psychopharmacology (Oxford, England) 2003;17(3):276–282. doi: 10.1177/02698811030173009.
    1. Reiss S, Peterson RA, Gursky DM, McNally RJ. Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour Research and Therapy. 1986;24(1):1–8. doi: 10.1016/0005-7967(86)90143-9.
    1. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Dunbar, G C. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry. 1998;59(Suppl 20):22–33.
    1. Shear MK, Brown TA, Barlow DH, Money R, Sholomskas DE, Woods SW, Papp LA. Multicenter collaborative panic disorder severity scale. American Journal of Psychiatry. 1997;154(11):1571–1575. doi: 10.1176/ajp.154.11.1571.
    1. Wilhelm FH, Trabert W, Roth WT. Characteristics of sighing in panic disorder. Biological Psychiatry. 2001;49(7):606–614. doi: 10.1016/S0006-3223(00)01014-3.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa