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.
Highlights
Hyperventilation and other respiratory abnormalities play a significant role in the etiology or maintenance of panic disorder (PD) (Klein 1993; Ley 1985)
At pre-treatment, PD severity was in the moderate range
The present study confirms prior results supporting the utility of P ETCO2 feedback in the respiratory treatment of PD
Summary
Hyperventilation and other respiratory abnormalities play a significant role in the etiology or maintenance of panic disorder (PD) (Klein 1993; Ley 1985). The acute effects of hyperventilation and compensatory mechanisms include many physiological sensations that are consistent with those seen in anxiety and panic, including gastrointestinal. Meuret et al (2008) reported outcomes from capnometry-assisted respiratory training (CART), which measured and provided feedback on PETCO2 over 4 weeks. Sustained increases in PETCO2 levels and significant reduction in panic symptom severity and frequency were documented. The aim of the present study was to replicate and extend the findings of Meuret et al (2008) using a novel system, and to benchmark the effectiveness of Capnometry Guided Respiratory Intervention (CGRI) in a clinically representative sample of PD patients seeking treatment in naturalistic clinical settings vs the academic centers where prior CART studies were performed
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