Respiratory Control: Its Contribution to the Treatment of Panic Attacks: A Controlled Study
Abstract
Patients who experienced panic attacks, with or without avoidance, were treated for two weeks with either training in controlled breathing or a placebo treatment. Subsequently, both groups received a limited period of conventional anxiety treatments, most commonly in vivo exposure. Patients were subdivided into 'hyperventilators' and 'non-hyperventilators' on the basis of the conventional provocation test. Observer ratings of anxiety showed a greater improvement for the group that received breathing training, but there was no evidence that 'hyperventilators' benefited more from respiratory training than 'non-hyperventilators'. Self-report measures of anxiety, avoidance, and depression/dysphoria showed no difference between treatments. These findings suggest that training in controlled breathing is not of specific benefit for those identified as 'hyperventilators' by the provocation test, but that it may have a non-specific effect in the treatment of patients with panic attacks.
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Hibbert and Chan (1989) found BRT and supportive therapy equal in the first two weeks, but after exposure training BRT produced more clinician-rated improvement, though not more self-reported improvement.
“The interventions were equally effective in the first 2-week phase, but BRT yielded greater improvement in clinician (but not self-report) ratings than supportive therapy following the additional exposure training.”
From Coping Skills and Exposure Therapy in Panic Disorder and Agoraphobia: Latest Advances and Future Directions (2012) · cites this paper as Hibbert & Chan, 1989
Cites
Respiratory control as a treatment for panic attacks
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“Hibbert and Chan (1989) proposed that placebo mechanisms may explain the beneficial effects of breathing retraining (Garssen, de Ruiter, & van Dyck, 1992).”
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“However, other studies |~ave found less favorable results of tneathing retraining in panic disorder (Hibbert and Chan 1989; de Ruiter et al 1989b).”
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“The percentage of hyperventilators identified by Bonn et al. (1984) among candidate patients with symptoms of hyperventilation is high compared to that of Hibbert and Chan (1989), who identified 13 of 21 candidates as hyperventilators.”
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Meuret, A. E., Wilhelm, F. H., Ritz, T., & Roth, W. T. (2003) · Behavior Modification · doi:10.1177/0145445503256324 · Cited by 81 · see citing works
“Two studies (Bonn, Readhead, & Timmons, 1984; Craske et al., 1997) used exposure treatment, two studies (Franklin, 1989; Schmidt et al., 2000) used waiting-list control groups, and one study (Hibbert & Chan, 1989) used a placebo treatment to evaluate the effectiveness of BT.”
BackgroundMethodInfluentialBreathing retraining: A rational placebo?
Garssen, B., de Ruiter, C., & van Dyck, R. (1992) · Clinical Psychology Review · doi:10.1016/0272-7358(92)90111-k · Cited by 76 · see citing works
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“In the study by Hibbert and Chan (1989), PD/A patients were randomly assigned to receive either 2 weeks of BRT or supportive therapy followed by 3 weeks of in vivo exposure.”
MethodBreathwork Interventions for Adults with Clinically Diagnosed Anxiety Disorders: A Scoping Review
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“The results of this study align with others included in this review, wherein positive outcomes of PD are observed when interventions include voluntary hyperventilation combined with slow, deep, or diaphragmatic breathing [62,64,66].”
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“For decades anxiety treatments either alone or as part of a treatment package have been directed at combating hyperventilation (e.g., Clark et al. 1985; Craske et al. 1997; Hibbert and Chan 1989; Meuret et al. 2008; Salkovskis et al. 1986; Schmidt et al. 2000).”
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“Hibbert and Chan (1989) treated panic patients with two sessions of either breathing retraining or a control condition, followed in each case by three sessions of situational exposure or other anxiety management strategies (e.g. distraction, use of coping statements).”
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“Hibbert (45) also found that breathing training alleviates panic even in patients who do not hyperventilate.”
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“…Salkovskis, & Chalkley, 1985; Rapee, 1985; Salkovskis, Jones, & Clark, 1986); however, results from the only placebo-controlled trial suggest that the effects of breathing retraining on panic attack frequency and severity do not exceed those produced by a credible placebo (Hibbert & Chan, 1989).”
BackgroundResultManagement of Patients with Hyperventilation-Related Disorders
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WILL HYPERVENTILATION SYNDROME SURVIVE?: A REJOINDER TO LEY (1993)
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“The few studies that used adequate comparison groups (Hibbert & Chan, 1989; Vlaander-van der Giessen, 1986) did not support the HVS model of panic.”
BackgroundDth jaargang 1992, nummer 3: Hyperventilatie en paniek Is ademtherapie een rationele placebo?
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- Authors
- Hibbert, G. A., & Chan, M.
- Affiliations
- Warneford Hospital (GB)
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 1989-02
- Volume
- 154
- Issue
- 2
- Pages
- 232-236
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2017550032
- Cited by
- 55
- References
- 0
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 1 · 2023: 2 · 2022: 1 · 2021: 2 · 2018: 1 · 2014: 2 · 2013: 2 · 2012: 1
- FWCI
- 4.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- 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
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- panic attacks, breath control, respiratory control, hyperventilation, provocation tests, in vivo exposure, avoidance, anxiety treatment, non-specific treatment effects, depression
- MeSH terms
- Adolescent, Adult, Anxiety Disorders, Breathing Exercises, Clinical Trials as Topic, Fear, Female, Humans, Hyperventilation, Male, Middle Aged, Panic, Phobic Disorders, Psychotherapy
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