Changes in respiration mediate changes in fear of bodily sensations in panic disorder
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The purpose of the study was to examine whether changes in pCO(2) mediate changes in fear of bodily sensation (as indexed by anxiety sensitivity) in a bio-behavioral treatment for panic disorder that targets changes in end-tidal pCO(2). Thirty-five panic patients underwent 4 weeks of capnometry-assisted breathing training targeting respiratory dysregulation. Longitudinal mediation analyses of the changes in fear of bodily symptoms over time demonstrated that pCO(2), but not respiration rate, was a partial mediator of the changes in anxiety sensitivity. Results were supported by cross lag panel analyses, which indicated that earlier pCO(2) levels predicted later levels of anxiety sensitivity, but not vice versa. PCO(2) changes also led to changes in respiration rate, questioning the importance of respiration rate in breathing training. The results provide little support for changes in fear of bodily sensations leading to changes in respiration, but rather suggest that breathing training targeting pCO(2) reduced fear of bodily sensations in panic disorder.
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Longitudinal mediation analyses indicated that changes in PCO2 measured continuously during between-session exercises mediated and preceded changes in fear of bodily sensations and cognitive reappraisal of symptoms and perceived control in CART but not CT.
“longitudinal mediation analyses indicating that changes in PCO2, measured continuously during between-session exercises, indeed mediated and preceded changes in fear of bodily sensations (Meuret et al., 2009) and cognitive reappraisal of symptoms and perceived control (Meuret et al., 2010) in CART but not CT.”
From Coping Skills and Exposure Therapy in Panic Disorder and Agoraphobia: Latest Advances and Future Directions (2012) · cites this paper as Meuret et al., 2009
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredPD/A patients and asthma patients in capnometry-assisted studies showed high compliance with assigned 17-minute twice-daily homework exercises.
“PD/A patients (Meuret et al., 2008) and patients with asthma in another capnometry-assisted study (Meuret, Rosenfield, Hofmann, Suvak, & Roth, 2009) demonstrated high compliance with the assigned 17-min, twice-daily homework exercises.”
From Coping Skills and Exposure Therapy in Panic Disorder and Agoraphobia: Latest Advances and Future Directions (2012) · cites this paper as Meuret, Rosenfield, Hofmann, Suvak, & Roth, 2009
The Methods (sections 2.3–2.4; page unavailable) report capnometry-assisted homework and high compliance: patients completed 47.6 of 52 assigned exercises on average. But this paper studies patients with panic disorder, not the asthma patients for whom the citing sentence invokes it, and the cited passages do not establish a 17-minute, twice-daily schedule. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThere was little evidence that RR was related to changes in symptom appraisal or panic symptom severity, despite its successful reduction in CART.
“However, as we found in a previous investigation (Meuret et al., 2009), there was little evidence that RR was related to changes in symptom appraisal or panic symptom severity, despite its successful reduction in CART.”
From Respiratory and cognitive mediators of treatment change in panic disorder: Evidence for intervention specificity. (2010) · cites this paper as Meuret et al., 2009
Results §4.2 reports that CART changed both respiration rate (RR) and anxiety sensitivity (a measure of fearful symptom appraisal), but found no significant relationship between them. The paper does not test whether RR changes were related to changes in panic symptom severity; its Introduction reports a reduction in panic severity but attributes that finding to an earlier study. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThese results replicated findings from a previous study demonstrating that PCO2 mediated and drove changes in symptom appraisal (anxiety sensitivity) in CART and refute prior notions that breathing techniques are likely to sustain rather than modify catastrophic cognitions.
“These results replicated findings from a previous study demonstrating that PCO2 mediated and drove changes in symptom appraisal (anxiety sensitivity) in CART (Meuret et al., 2009) and refute prior notions that breathing techniques “are likely to sustain rather than modify catastrophic cognitions” (Salkovskis, Clark, & Gelder, 1996, p. 457).”
From Respiratory and cognitive mediators of treatment change in panic disorder: Evidence for intervention specificity. (2010) · cites this paper as Meuret et al., 2009
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredReductions in rate of breathing did not mediate reductions in panic fear of bodily sensations, panic symptom severity, or cognitions including perceived control.
“reductions in rate of breathing neither mediated reductions in panic fear of bodily sensations (Meuret et al., 2009) nor panic symptom severity or cognitions (including perceived control) (Meuret et al., 2010).”
From Coping Skills and Exposure Therapy in Panic Disorder and Agoraphobia: Latest Advances and Future Directions (2012) · cites this paper as Meuret et al., 2009
These proportions are comparable to recently published longitudinal MLM analyses of anxiety intervention studies that examined cognitions (typically 10%-30%) and physiology (20%-40%).
“These proportions are comparable to recently published longitudinal MLM analyses of anxiety intervention studies that examined cognitions (typically 10%–30%; cf. Hofmann et al., 2007; Smits et al., 2006) and physiology (20%–40%; Meuret et al., 2009) as mediators of treatment change.”
From Respiratory and cognitive mediators of treatment change in panic disorder: Evidence for intervention specificity. (2010) · cites this paper as Meuret et al., 2009
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- Authors
- Meuret, A. E., Rosenfield, D., Hofmann, S. G., Suvak, M. K., & Roth, W. T.
- Affiliations
- Southern Methodist University (US)
- Boston University (US)
- Stanford Medicine (US)
- Corresponding author
- Meuret, Alicia E.
- Venue
- Journal of Psychiatric Research
- Publisher
- Elsevier BV
- Published
- 2009-03
- Volume
- 43
- Issue
- 6
- Pages
- 634-641
- ISSN
- 0022-3956 (ISSN-L)
- PMC
- PMC3327292
- OpenAlex
- W2034271478
- Cited by
- 67
- References
- 65
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 4 · 2023: 1 · 2022: 2 · 2021: 2 · 2020: 4 · 2019: 3 · 2018: 3 · 2017: 3 · 2016: 4 · 2015: 1 · 2014: 2 · 2013: 7 · 2012: 5
- FWCI
- 9.98
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Psychiatric Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL089761)
- 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
- panic disorder, anxiety sensitivity, end-tidal PCO2, respiration rate, mediation
- MeSH terms
- Adolescent, Adult, Anxiety Disorders, Blood Gas Monitoring, Transcutaneous, Breathing Exercises, Fear, Female, Humans, Longitudinal Studies, Male, Middle Aged, Respiration, Time Factors, Panic Disorder, Hypocapnia, Treatment Outcome, Young Adult
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