Respiratory Therapeutic Procedures in Panic Disorder

恐慌症的呼吸治疗程序

• 批准号: 7095176
• 负责人: WALTON Thompson ROTH
• 金额: $ 25.71万
• 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 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7095176
• 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（由申请人提供）：过度换气和窒息报警恐慌理论以及最近的研究结果都指向呼吸失调在恐慌症中的核心作用。惊恐障碍的认知行为治疗包通常包括呼吸训练和过度通气暴露，但对它们的生理作用和对结果的具体贡献知之甚少。我们对基于家庭的pCO2反馈辅助呼吸训练的初步研究表明，教导患者提高pCO2可以相当迅速地缓解某些恐慌症状，但是否通过防止过度换气来实现这一点尚不确定。我们建议比较两种基于对立理论的呼吸训练的结果。在这个为期3年的项目中，我们将招募75名惊恐障碍患者和25名非焦虑对照。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（基于窒息报警理论），或等待名单。将在5个疗程、4周疗程之前、期间、1个月和6个月后对患者进行评价。除了通常的临床结果测量外，我们还将收集呼吸变化的体内证据，包括对标准化基础激活和过度通气测试的响应，以及使用新型评估系统在24小时监测期间的其他时间。我们的假设包括以下：1）与较低CO2程序或等待治疗相比，升高CO2程序将产生更多的惊恐发作频率和严重程度的降低。如果这一共同假设不成立，而两种程序都产生了类似的改善，我们可以推断它们的作用是非特异性的。2)在测试期间和24小时监测期间，与训练前相比，升高CO2呼吸训练将导致较高的pCO2水平，而较低CO2呼吸训练将导致较低的pCO2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，通过初始呼吸系统症状和呼吸系统异常可以更好地预测两种呼吸训练程序对惊恐发作频率和严重程度的临床改善。如果这是真的，呼吸训练的治疗应用应限于有呼吸不适的患者。此外，我们将在生态有效的环境中描述患者治疗前呼吸功能障碍的特征。该建议的一般意义在于其多模式评估呼吸训练作为治疗某些惊恐障碍症状的程序，并将深入的呼吸评估扩展到实验室之外更长的时间段，从而更好地了解这种疾病的呼吸失调。

项目成果

Methodological considerations in ambulatory skin conductance monitoring.

• DOI: 10.1016/j.ijpsycho.2011.02.002
• 发表时间: 2011-05
• 期刊: INTERNATIONAL JOURNAL OF PSYCHOPHYSIOLOGY
• 影响因子: 3
• 作者: Doberenz, Sigrun;Roth, Walton T.;Wollburg, Eileen;Maslowski, Nina I.;Kim, Sunyoung
• 通讯作者: Kim, Sunyoung

Psychophysiological reactions to two levels of voluntary hyperventilation in panic disorder.

惊恐障碍中两种水平的自愿过度换气的心理生理反应。

• DOI: 10.1016/j.janxdis.2007.09.004
• 发表时间: 2008
• 期刊: Journal of anxiety disorders
• 影响因子: 10.3
• 作者: Wollburg,Eileen;Meuret,AliciaE;Conrad,Ansgar;Roth,WaltonT;Kim,Sunyoung
• 通讯作者: Kim,Sunyoung

Effects of breathing training on voluntary hypo- and hyperventilation in patients with panic disorder and episodic anxiety.

呼吸训练对惊恐障碍和阵发性焦虑患者自愿通气不足和过度通气的影响。

• DOI: 10.1007/s10484-011-9150-5
• 发表时间: 2011
• 期刊: Applied psychophysiology and biofeedback
• 影响因子: 3
• 作者: Wollburg,Eileen;Roth,WaltonT;Kim,Sunyoung
• 通讯作者: Kim,Sunyoung

Diversity of effective treatments of panic attacks: what do they have in common?

惊恐发作的有效治疗方法多种多样：它们有什么共同点？

• DOI: 10.1002/da.20601
• 发表时间: 2010
• 期刊: Depression and anxiety
• 影响因子: 7.4
• 作者: Roth,WaltonT

Sympathetic activation in broadly defined generalized anxiety disorder.

广义广泛性焦虑症中的交感神经激活。

• DOI: 10.1016/j.jpsychires.2006.12.003
• 发表时间: 2008
• 期刊: Journal of psychiatric research
• 影响因子: 4.8
• 作者: Roth,WaltonT;Doberenz,Sigrun;Dietel,Anja;Conrad,Ansgar;Mueller,Anett;Wollburg,Eileen;Meuret,AliciaE;BarrTaylor,C;Kim,Sunyoung
• 通讯作者: Kim,Sunyoung