Respiratory Therapeutic Procedures in Panic Disorder

恐慌症的呼吸治疗程序

• 批准号: 6825619
• 负责人: WALTON Thompson ROTH
• 金额: $ 25.87万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-07-19 至 2007-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6825619
• 关键词: behavioral /social science research tag; biofeedback; clinical research; human subject; human therapy evaluation; hypercapnia; hyperpnea; hypocapnia; interview; medical complication; panic disorder; psychophysiology; questionnaires; respiratory disorder; respiratory hypoxia; respiratory therapy

DESCRIPTION (provided by applicant): Both the hyperventilation and suffocation alarm theories of panic together with recent research findings point towards a central role for respiratory dysregulation in Panic Disorder. Cognitive-behavioral treatment packages for Panic Disorder typically include respiratory training and hyperventilation exposure, but little is known about their physiological effects and specific contribution to outcome. Our preliminary study of home-based pCO2 feedback-assisted respiratory training suggests that teaching patients to raise their pCO2 relieves certain panic symptoms fairly rapidly, but whether it does so by preventing hyperventilation is uncertain. We propose comparing the results of two kinds of breathing training based on opposing theories. In this 3-year project we will recruit 75 Panic Disorder patients and 25 non-anxious controls. Patients will be randomly assigned to one of three groups: raise-pCO2 respiratory training (based on the hyperventilation theory), lower pCO2 respiratory training (based on the suffocation alarm theory), or waiting-list. Patients will be evaluated before, during, and at 1 month and 6 months after a 5-session, 4-week course of therapy. Besides the usual clinical outcome measures, we will gather in-vivo evidence for changes in respiration, both in response to standardized basal activation and hyperventilation tests and at other times during 24-hour monitoring using novel assessment systems. Our hypotheses include the following: 1) The raise-C02 procedure will produce more reduction in the frequency and severity of panic attacks than the lower-C02 procedure or waiting for treatment. If this common assumption is not upheld, and both procedures produce similar improvement, we can infer that they work nonspecifically. 2) The raise-C02 breathing training will lead to higher pC02 levels and the lower-C02 breathing training to lowerpC02 levels during tests and during 24-hour monitoring than before training. If this is not true, we will know that what is learned during the sessions is not transferred to other situations. 3) Clinical improvement in frequency and severity of panic attacks for both breathing training procedures will be better predicted by initial respiratory symptoms and respiratory abnormalities than by cardiac symptoms. If this is true, therapeutic application of breathing training should be restricted to patients with breathing complaints. In addition, we will characterize patients' pre-treatment respiratory dysfunction in ecologically valid settings. The general significance of this proposal lies in its multi-modal evaluation of respiratory training as a procedure for treating certain Panic Disorder symptoms and its extension of in-depth respiratory assessment beyond the laboratory for longer time periods, affording a better understanding of respiratory dysregulation in this disorder.

描述(申请人提供)：恐慌的过度换气和窒息警报理论以及最近的研究结果都表明呼吸调节障碍在恐慌症中起着核心作用。恐慌症的认知行为治疗方案通常包括呼吸训练和过度换气暴露，但人们对它们的生理影响和对结果的具体贡献知之甚少。我们对家庭二氧化碳反馈辅助呼吸训练的初步研究表明，教导患者提高二氧化碳分压可以相当快地缓解某些恐慌症状，但是否通过防止过度换气来做到这一点还不确定。我们建议基于相反的理论来比较两种呼吸训练的结果。在这个为期3年的项目中，我们将招募75名恐慌症患者和25名非焦虑对照组。患者将被随机分配到三组中的一组：提高PCO2呼吸训练(基于过度换气理论)、降低PCO2 呼吸训练(基于窒息警报理论)，或等待名单。患者将在治疗前、治疗中、治疗后1个月和6个月进行评估，疗程为5个疗程，为期4周。除了通常的临床结果指标外，我们还将收集呼吸变化的体内证据，包括对标准化的基础激活和过度换气测试的反应，以及在使用新的评估系统进行24小时监测期间的其他时间。我们的假设包括：1)RAISE-C02程序比LOWER-C02程序或等待治疗更能减少惊恐发作的频率和严重程度。如果这一共同的假设没有得到支持，而且两种程序都产生了类似的改善，我们可以推断它们的工作是非特定的。2)与训练前比较，RAISE-CO_2呼吸训练可导致较高的pCO_2水平，而较低的CO_2呼吸训练可导致较低的pCO_2水平。如果这不是真的，我们将知道在会议期间学到的东西不会转移到其他情况。3)与心脏症状相比，最初的呼吸症状和呼吸异常能更好地预测两种呼吸训练中惊恐发作频率和严重程度的临床改善。如果这是真的，呼吸训练的治疗性应用应该仅限于有呼吸主诉的患者。此外，我们将在生态有效的环境中描述患者治疗前的呼吸功能障碍。这项建议的总体意义在于，它对呼吸训练作为治疗某些恐慌性障碍症状的程序进行了多模式评估，并将深入的呼吸评估延长到实验室以外的更长时间，从而更好地了解这种疾病的呼吸失调。