Respiratory biofeedback-assisted therapy in panic disorder
Open accessAbstract
The authors describe a new methodologically improved behavioral treatment for panic patients using respiratory biofeedback from a handheld capnometry device. The treatment rationale is based on the assumption that sustained hypocapnia resulting from hyperventilation is a key mechanism in the production and maintenance of panic. The brief 4-week biofeedback therapy is aimed at voluntarily increasing self-monitored end-tidal partial pressure of carbon dioxide (PCO 2 ) and reducing respiratory rate and instability through breathing exercises in patients’ environment. Preliminary results from 4 patients indicate that the therapy was successful in reducing panic symptoms and other psychological characteristics associated with panic disorder. Physiological data obtained from home training, 24-hour ambulatory monitoring pretherapy and posttherapy, and laboratory assessment at follow-up indicate that patients started out with low resting PCO 2 levels, increased those levels during therapy, and maintained those levels at posttherapy and/or follow-up. Partial dissociation between PCO 2 and respiratory rate questions whether respiratory rate should be the main focus of breathing training in panic disorder.
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Initial case studies supported the potential usefulness of capnometry-assisted breathing training.
“Initial case studies supported the potential usefulness of this approach (Meuret et al., 2001; Meuret et al., 2004).”
From Feedback of end-tidal pCO2 as a therapeutic approach for panic disorder (2008) · cites this paper as Meuret et al., 2001
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“The lack of PCO2 monitoring during training could explain the relatively small improvement with standard breathing training reported in several studies (de Ruiter, Rijken, Garssen, & Kraaimaat, 1989; Hibbert & Chan, 1989; Schmidt et al., 2000).”
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Domschke, K., Stevens, S., Pfleiderer, B., & Gerlach, A. L. (2010) · Clinical Psychology Review · doi:10.1016/j.cpr.2009.08.008 · Cited by 580 · see citing works
Biofeedback for Psychiatric Disorders: A Systematic Review
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Feedback of end-tidal pCO2 as a therapeutic approach for panic disorder
Meuret, A. E., Wilhelm, F. H., Ritz, T., & Roth, W. T. (2008) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2007.06.005 · Cited by 159 · see citing works
Self-citationHyperventilation in panic disorder and asthma: Empirical evidence and clinical strategies
Meuret, A. E., & Ritz, T. (2010) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2010.05.006 · Cited by 118 · see citing works
Self-citationMeuret, A. E., Ritz, T., Wilhelm, F. H., & Roth, W. T. (2005) · Clinical Psychology Review · doi:10.1016/j.cpr.2005.01.002 · Cited by 84 · see citing works
Self-citationBreathing Training for Treating Panic Disorder: Useful Intervention or Impediment?
Meuret, A. E., Wilhelm, F. H., Ritz, T., & Roth, W. T. (2003) · Behavior Modification · doi:10.1177/0145445503256324 · Cited by 81 · see citing works
Self-citationThe psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm
Ritz, T., Meuret, A. E., & Ayala, E. S. (2010) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2010.05.007 · Cited by 74 · see citing works
“5.2.3 Hypoventilation techniques—Based on prior work targeting hyperventilation in panic disorder patients (Meuret et al., 2008; 2004; 2001), we recently pilot-tested a hypoventilation technique that attempted to target the respiratory dysregulation observed in BII patients (Ayala, Ritz, et al.…”
MethodInfluentialSelf-citationChanges in respiration mediate changes in fear of bodily sensations in panic disorder
Meuret, A. E., Rosenfield, D., Hofmann, S. G., Suvak, M. K., & Roth, W. T. (2009) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2008.08.003 · Cited by 67 · see citing works
Self-citationBreathwork Interventions for Adults with Clinically Diagnosed Anxiety Disorders: A Scoping Review
Banushi, B., Brendle, M., Ragnhildstveit, A., Murphy, T., Moore, C., Egberts, J., & Robison, R. (2023) · Brain Sciences · doi:10.3390/brainsci13020256 · Cited by 58 · see citing works
Catastrophic Appraisal and Perceived Control as Moderators of Treatment Response in Panic Disorder
Meuret, A. E., Hofmann, S. G., & Rosenfield, D. (2010) · International Journal of Cognitive Therapy · doi:10.1521/ijct.2010.3.3.262 · Cited by 28 · see citing works
Self-citationA wearable and mobile intervention delivery system for individuals with panic disorder
Cruz, L., Rubin, J., Abreu, R., Ahern, S., Eldardiry, H., & Bobrow, D. G. (2015) · Proceedings of the 14th International Conference on Mobile and Ubiquitous Multimedia · doi:10.1145/2836041.2836058 · Cited by 28 · see citing works
- Authors
- Meuret, A. E., Wilhelm, F. H., & Roth, W. T.
- Affiliations
- Stanford University (US)
- Corresponding author
- Meuret, Alicia E.
- Venue
- Behavior Modification
- Publisher
- SAGE Publications
- Published
- 2001-09
- Volume
- 25
- Issue
- 4
- Pages
- 584-605
- ISSN
- 0145-4455 (ISSN-L)
- 1552-4167
- OpenAlex
- W2062158200
- Cited by
- 107
- References
- 13
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 2 · 2023: 5 · 2022: 6 · 2021: 3 · 2020: 5 · 2019: 5 · 2018: 6 · 2017: 3 · 2016: 2 · 2015: 7 · 2014: 9 · 2013: 3 · 2012: 1
- FWCI
- 5.61
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Behavior Modification (publishedVersion)
- PubMed (publishedVersion)
- edoc (University of Basel) (acceptedVersion)
- edoc (University of Basel)
- Funders
- National Institute of Mental Health (MH 56094, 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
- panic disorder, respiratory biofeedback, capnometry, hypocapnia, hyperventilation, end-tidal carbon dioxide, breathing exercises, self-monitoring, respiratory rate, behavior therapy, ambulatory monitoring
- MeSH terms
- Adult, Biofeedback, Psychology, Carbon Dioxide, Female, Humans, Hyperventilation, Male, Respiration, Panic Disorder, Treatment Outcome
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