Respiratory Dysregulation in Anxiety, Functional Cardiac, and Pain Disorders: Assessment, Phenomenology, and Treatment
Abstract
Respiration is a complex physiological system affecting a variety of physical processes that can act as a critical link between mind and body. This review discusses the evidence for dysregulated breathing playing a role in three clinical syndromes: panic disorder, functional cardiac disorder, and chronic pain. Recent technological advances allowing the ambulatory assessment of endtidal partial pressure of CO2 (PCO2) and respiratory patterns have opened up new avenues for investigation and treatment of these disorders. The latest evidence from laboratories indicates that subtle disturbances of breathing, such as tidal volume instability and sighing, contribute to the chronic hypocapnia often found in panic patients. Hypocapnia is also common in functional cardiac and chronic pain disorders, and studies indicate that it mediates some of their symptomatology. Consistent with the role of respiratory dysregulation in these disorders, initial evidence indicates efficacy of respiration-focused treatment.
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Sighing is more frequent (up to 15 times in a 15 min period) and associated with dyspnoea in those with dysfunctional breathing.
“Sighing occurs in healthy individuals and asthmatics, but is more frequent (up to 15 times in a 15 min period) and associated with dyspnoea in those with dysfunctional breathing [8, 45, 46, 61].”
From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [61]
Sighing occurs in healthy individuals and asthmatics.
“Sighing occurs in healthy individuals and asthmatics, but is more frequent (up to 15 times in a 15 min period) and associated with dyspnoea in those with dysfunctional breathing [8, 45, 46, 61].”
From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [61]
Breathing engages in a reciprocal relationship with stress and anxiety, whereby stress and anxiety can both affect and be affected by altered respiratory patterns.
“Breathing also uniquely engages in a reciprocal relationship with stress and anxiety, whereby stress and anxiety can both affect [28,29,30,31,32,33] and be affected by [20,21,22,34] altered respiratory patterns.”
Populations with particularly dysregulated breathing may fare better with one-on-one attention, given small number of group interventions in high-anxiety and acute chronic populations.
“However, given the small number of group interventions in high-anxiety and acute chronic populations, it is possible that populations with particularly dysregulated breathing [28,29,33] may fare better with one-on-one attention.”
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Dysfunctional breathing: a review of the literature and proposal for classification
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- Authors
- Wilhelm, F. H., Gevirtz, R., & Roth, W. T.
- Affiliations
- Stanford University (US)
- Alliant University (US)
- United States Department of Veterans Affairs (US)
- Venue
- Behavior Modification
- Publisher
- SAGE Publications
- Published
- 2001-09
- Volume
- 25
- Issue
- 4
- Pages
- 513-545
- ISSN
- 0145-4455 (ISSN-L)
- 1552-4167
- OpenAlex
- W2147895930
- Cited by
- 134
- References
- 5
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 4 · 2023: 9 · 2022: 3 · 2021: 5 · 2020: 2 · 2019: 4 · 2018: 5 · 2017: 6 · 2016: 8 · 2015: 2 · 2014: 12 · 2013: 12 · 2012: 4
- FWCI
- 2.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behavior Modification (publishedVersion)
- PubMed (publishedVersion)
- edoc (University of Basel) (acceptedVersion)
- Funders
- National Institute of Mental Health (MH 56094, R01MH056094)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- panic disorder, chronic pain, hypocapnia, sighing, breathing pattern, mind-body problem
- MeSH terms
- Anxiety Disorders, Arousal, Behavior Therapy, Humans, Neurocirculatory Asthenia, Pain, Personality Assessment, Respiration Disorders, Pain Management
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