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Cited by 32Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychosomatic Disorders and Their TreatmentsNeuroscience of respiration and sleep

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Do blood phobia patients hyperventilate during exposure by breathing faster, deeper, or both?

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Ritz, Thomas, Wilhelm, Frank H., Meuret, Alicia E., Gerlach, Alexander L., Roth, Walton T.·2009·Depression and Anxiety
DOI 10.1002/da.20466
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Abstract

Background Recently we found that patients with blood-injection-injury (BII) phobia tend to hyperventilate when exposed to feared stimuli. Hyperventilation results from increases in minute ventilation above levels required by metabolic demand and can result from increases in either frequency or depth of breathing, or a combination of both. Method In order to determine which of these factors contributed most to hyperventilation in BII phobia we analyzed breathing patterns of BII phobia patients (N=12) and non-anxious controls (N=14), recorded with respiratory inductance plethysmography. Participants viewed ten film clips of either an emotionally positive, negative, or neutral quality, as well as surgery and asthma-relevant clips. During five film clips (one from each category) they also tensed their leg muscles. Results Minute ventilation was markedly increased in blood phobia patients compared to other groups during surgery films. Also, tidal volume and irregularity of tidal volume showed strong increases, while respiration rate was not affected. Leg muscle tension increased ventilation in general but far below the extent brought about by hyperventilation in BII phobia. Patients who were breathing deeper during exposure reported stronger symptoms of dizziness, light-headedness and faintness. In general, patients showed a higher rate of spontaneous sighs throughout all film presentations, but not at baseline. Conclusion Thus, hyperventilation in blood phobia is produced by exc…

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  • Marked increases in tidal volume paired with no substantial changes in respiration rate have been observed in BII-phobia patients during exposure to surgery films.

    “Given that marked increases in tidal volume paired with no substantial changes in respiration rate have been observed in BII-phobia patients during exposure to surgery films (Ritz et al., 2009; Ayala et al., 2010), a lack of control for tidal volume effects could lead to inflated RSA values suggesting a parasympathetic discharge.”

    From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Ritz et al., 2009

  • The basis of this hyperventilation seems to be a marked increase in tidal volume, rather than an increase in respiration rate.

    “The basis of this hyperventilation seems to be a marked increase in tidal volume, rather than an increase in respiration rate (Ritz et al., 2009).”

    From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Ritz et al., 2009

  • In both studies, tidal volume and minute ventilation, but not respiration rate, as well as breathing irregularity correlated with the experience of a variety of symptoms, most prominently shortness of breath, lightheadedness, dizziness, and faintness.

    “In both studies, tidal volume and minute ventilation, but not respiration rate, as well as breathing irregularity correlated with the experience of a variety of symptoms, most prominently shortness of breath, lightheadedness, dizziness, and faintness (Ayala et al., 2010; Ritz et al., 2009).”

    From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Ritz et al., 2009

  • Patients with greater disgust responses also showed greater drops in PCO2 or stronger increases in ventilation during and/or following film presentations.

    “Patients with greater disgust responses also showed greater drops in PCO2 (Ritz et al., 2005) or stronger increases in ventilation (Ayala et al., 2010; Ritz et al., 2009) during and/or following film presentations.”

    From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Ritz et al., 2009

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Research works printed but not linked: 34

  1. Engel, 1978, Psychological stress, vasodepressor (vasovagal) syncope, and sudden death, Ann Intern Med, 89, 403, 10.7326/0003-4819-89-3-403 · DOI · Paper page
  2. Graham, 1961, Vasovagal fainting: a diphasic response, Psychosom Med, 23, 493, 10.1097/00006842-196111000-00004 · DOI · Paper page
  3. Kleinknecht, 1990, Types and correlates of blood/injury-related vasovagal syncope, Behav Res Ther, 28, 289, 10.1016/0005-7967(90)90080-3 · DOI · Paper page
  4. Page, 1994, Blood-injury phobia, Clin Psychol Rev, 14, 443, 10.1016/0272-7358(94)90036-1 · DOI
  5. Ritz, 2005, End-tidal pCO2 in blood phobics during viewing of emotion- and disease-related films, Psychosom Med, 67, 661, 10.1097/01.psy.0000170339.06281.07 · DOI · Paper page
  6. Wientjes, 1992, Respiration in psychophysiology: methods and applications, Biol Psychiatry, 34, 179, 10.1016/0301-0511(92)90015-M · DOI
  7. Steptoe, 1988, Emotional fainting and the psychophysiologic response to blood and injury: autonomic mechanisms and coping strategies, Psychosom Med, 50, 402, 10.1097/00006842-198807000-00008 · DOI · Paper page
  8. Vögele, 2003, Psychophysiologic effects of applied tension on the emotional fainting response to blood and injury, Behav Res Ther, 41, 139, 10.1016/S0005-7967(01)00133-4 · DOI · Paper page
  9. Gerlach, 2006, Blood-injury phobia with and without a history of fainting: disgust sensitivity does not explain the fainting response, Psychosom Med, 68, 331, 10.1097/01.psy.0000203284.53066.4b · DOI · Paper page
  10. Lipsitz, 1997, Vasomotor instability preceding tilt-induced syncope: does respiration play a role?, J Appl Physiol, 83, 383, 10.1152/jappl.1997.83.2.383 · DOI
  11. First, 1994, Structured Clinical Interview of DSM IV: Patient Edition (SCID-I/P). Version 2.0
  12. Gross, 1995, Emotion elicitation using films, Cogn Emotion, 9, 87, 10.1080/02699939508408966 · DOI · Paper page
  13. Ten Harkel, 1994, Effects of leg muscle pumping and tensing on orthostatic arterial pressure: a study in normal subjects and patients with autonomic failure, Clin Sci, 87, 553, 10.1042/cs0870553 · DOI · Paper page
  14. Defares, 1988, Topics in Health Psychology, 141
  15. Ritz T, Wilhelm FH, Meuret AE, Gerlach A, Roth WT. Blood phobia patients hyperventilate during exposure by breathing deeper, not faster. Poster presented at the 26th Annual Conference of the Anxiety Disorders Association of America, Miami, FL; 2006: March 18-21.
  16. Wasserman, 1986, Handbook of Physiology, Sec. 3. The Respiratory System: Control of Breathing, 2, 595
  17. Paulev, 1991, Cardiorespiratory reactions to static, isometric exercise in man, Jpn J Physiol, 41, 785, 10.2170/jjphysiol.41.785 · DOI
  18. Pain, 1988, Panic disorder, the ventilatory response to carbon dioxide and respiratory variables, Psychosom Med, 50, 541, 10.1097/00006842-198809000-00010 · DOI
  19. Papp, 1997, Respiratory psychophysiology of panic disorder: three respiratory challenges in 98 subjects, Am J Psychiatry, 154, 1557, 10.1176/ajp.154.11.1557 · DOI · Paper page
  20. Gorman, 1984, Response to hyperventilation in a group of patients with panic disorder, Am J Psychiatry, 141, 857, 10.1176/ajp.141.7.857 · DOI
  21. Abelson, 2001, Persistent respiratory irregularity in patients with panic disorder, Biol Psychiatry, 49, 588, 10.1016/S0006-3223(00)01078-7 · DOI · Paper page
  22. Wilhelm, 2001, Characteristics of sighing in panic disorder, Biol Psychiatry, 49, 606, 10.1016/S0006-3223(00)01014-3 · DOI
  23. Barlow, 2000, Mastery of Your Anxiety and Panic: Client Workbook for Anxiety and Panic
  24. Ley, 1991, The efficacy of breathing retraining and the centrality of hyperventilation in panic disorder: a reinterpretation of experimental findings, Behav Res Ther, 29, 301, 10.1016/0005-7967(91)90121-I · DOI · Paper page
  25. Ley, 2005, Blood, breath, fears redux, and panic attacks: comment on Roth, Wilhelm, and Pettit, Psychol Bull, 2, 193, 10.1037/0033-2909.131.2.193 · DOI
  26. Roth, 2005, Rescuing the hyperventilation theory of panic: reply, Psychol Bull, 131, 199, 10.1037/0033-2909.131.2.199 · DOI
  27. Roth, 2005, Are current theories of panic falsifiable?, Psychol Bull, 131, 171, 10.1037/0033-2909.131.2.171 · DOI
  28. Boiten, 1994, Emotions and respiratory patterns: review and critical analysis, Int J Psychophysiol, 17, 103, 10.1016/0167-8760(94)90027-2 · DOI · Paper page
  29. Van den Hout, 1992, Hyperventilation is not diagnostically specific to panic patients, Psychosom Med, 53, 182, 10.1097/00006842-199203000-00005 · DOI
  30. Hainsworth, 2004, Pathophysiology of syncope, Clin Auton Res, 14, 18, 10.1007/s10286-004-1004-2 · DOI
  31. Foulds, 1993, Cerebral circulation during treatment of blood-injury phobia: a case study, Behav Psychother, 21, 137, 10.1017/S0141347300018103 · DOI · Paper page
  32. Kozak, 1985, The psychophysiological process of therapy in a case of injury-scene-elicited fainting, J Behav Ther Exp Psychiatry, 16, 139, 10.1016/0005-7916(85)90049-7 · DOI · Paper page
  33. Öst, 1987, Applied tension. A specific behavioral method for treatment of blood phobia, Behav Res Ther, 25, 25, 10.1016/0005-7967(87)90111-2 · DOI · Paper page
  34. Meuret, 2004, Clinical Applications, 129

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Metadata

Authors
Ritz, T., Wilhelm, F. H., Meuret, A. E., Gerlach, A. L., & Roth, W. T.
Affiliations
  • Southern Methodist University (US)
  • University of Basel (CH)
  • University of Münster (DE)
  • VA Palo Alto Health Care System (US)
Corresponding author
Ritz, Thomas
ORCID
Venue
Depression and Anxiety
Publisher
Wiley
Published
2009-02
Volume
26
Issue
2
Pages
E60-E67
ISSN
  • 1091-4269 (ISSN-L)
  • 1520-6394
DOI
10.1002/da.20466
OpenAlex
W2103533900
Cited by
32
References
8
Citations by year
2025: 1 · 2024: 3 · 2022: 1 · 2020: 2 · 2018: 3 · 2017: 4 · 2016: 1 · 2014: 3 · 2013: 4 · 2012: 1
FWCI
2.50
Type
journal article
Language
en
Open access
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 2403 d)
Locations
  • Depression and Anxiety (publishedVersion)
  • PubMed (publishedVersion)
  • edoc (University of Basel) (acceptedVersion)
  • edoc (University of Basel)
Funders
National Institute of Mental Health (R01MH056094)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
Keywords
blood-injection-injury phobia, hyperventilation, breathing pattern, tidal volume, respiration rate, minute ventilation, muscle tension, syncope, dizziness, exposure therapy, dysfunctional breathing
MeSH terms
Adult, Arousal, Blood, Female, Humans, Hyperventilation, Injections, Male, Middle Aged, Phobic Disorders, Plethysmography, Whole Body, Respiration, Syncope, Wounds and Injuries, Young Adult

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