http://www.sciencedaily.com/releases/2010/12/101220200010.htm
New Breathing Therapy Reduces Panic and Anxiety by Reversing Hyperventilation
ScienceDaily (Dec. 22, 2010) — A new treatment program teaches people who suffer from panic disorder how to reduce the terrorizing symptoms by normalizing their breathing.
The method has proved better than traditional cognitive therapy at reducing both symptoms of panic and hyperventilation, according to a new study.
The biological-behavioral treatment program is called Capnometry-Assisted Respiratory Training, or CART, said psychologist and panic disorder expert Alicia E. Meuret at Southern Methodist University in Dallas.
CART helps patients learn to breathe in such a way as to reverse hyperventilation, a highly uncomfortable state where the blood stream operates with abnormally low levels of carbon dioxide, said Meuret, one of the researchers conducting the study.
Hyperventilation, a state of excessive breathing, results from deep or rapid breathing and is common in patients with panic disorders.
“We found that with CART it’s the therapeutic change in carbon dioxide that changes the panic symptoms — and not vice versa,” Meuret said.
CART: Breathing exercises twice a day
During the treatment, patients undergo simple breathing exercises twice a day. A portable capnometer device supplies feedback during the exercises on a patient’s CO2 levels. The goal of these exercises is to reduce chronic and acute hyperventilation and associated physical symptoms. This is achieved by breathing slower but most importantly more shallowly. Contrary to lay belief, taking deep breaths actually worsens hyperventilation and symptoms.
“Most panic-disorder patients report they are terrified of physical symptoms such as shortness of breath or dizziness,” Meuret said. “In our study, cognitive therapy didn’t change respiratory physiology, but CART did effectively reduce hyperventilation. CART was proved an effective and powerful treatment that reduces the panic by means of normalizing respiratory physiology.”
The findings, “Respiratory and cognitive mediators of treatment change in panic disorder: Evidence for intervention specificity,” appeared in the Journal of Consulting and Clinical Psychology. Meuret, who developed CART, is an assistant professor in the Department of Psychology at SMU and co-directs the department’s Stress, Anxiety and Chronic Disease Research Program. The Beth & Russell Siegelman Foundation funded the research.
CART breathing a proven biological therapy
The study pitted CART against a conventional cognitive therapy treatment, or CT. Traditional CT teaches patients techniques aimed at helping them change and reverse catastrophic thoughts in order to reduce fear and panic.
In the CART-CT study, 41 patients were assigned to complete either a CART or CT treatment program for panic disorder and agoraphobia, a fear of being trapped with no means of escape or help.
Both treatment programs were equally effective in reducing symptoms, said Meuret. But CART was the only treatment to physiologically alter panic symptoms by actively reversing hyperventilation in the patients. Cognitive therapy didn’t change the respiratory physiology, said Meuret.
Treatment helps patients address terror associated with panic
The study is the second randomized control trial to measure CART’s effectiveness. By reversing hyperventilation, patients reported a new ability to reduce panic symptoms by means of changing their respiration.
With CT, Meuret said, if a patient reports shortness of breath, the therapist challenges the assumption by asking how often the person actually has suffocated during a panic attack, then hopes that will reverse the patient’s thinking.
“I found that process very challenging for some of my patients because it acknowledges the symptom but says it’s not a problem,” Meuret said.
“CART, however, tells us a patient’s CO2 is very low and is causing many of the symptoms feared, but it can also show how to change these symptoms through correct breathing. There has been an assumption that if people worry less about symptoms it will also normalize their physiology, but this study shows that this is not the case,” she said. “Hyperventilation remains unchanged, which could be a risk factor for relapse down the road. Apart from hyperventilation being a symptom generator, it is an unhealthy biological state associated with negative health outcomes.”
Broader study planned to measure CART
The researchers plan to branch out with their studies on CART by taking the program into the community, particularly to ethnic minorities. They believe CART is a more universally understood treatment due to its physical exercises — as opposed to cognitive therapy’s more intellectual methods — and therefore more accessible to a broader range of people with varying levels of education and different cultural backgrounds. Ongoing studies will test the efficacy of CART in patients with asthma and fear of blood.
Co-authors of the study at SMU were David Rosenfield, associate psychology professor, and psychology graduate students Anke Seidel and Lavanya Bhaskara. Stefan G. Hofmann, psychology professor at Boston University, was also an author on the paper.
Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.
Story Source:
The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Southern Methodist University, via EurekAlert!, a service of AAAS.
ALSO RELATED
Hyperventilation
8 Tactics to Overcome It
The first time it happened, Gary Varner thought he was having a heart attack. “My heart was racing and it just felt like everything inside my body—my chest—was vibrating. And I felt some tingling.”
Understandably, he was scared. But at a hospital, emergency room doctors said his heart was fine. Their diagnosis: hyperventilation.
Simply put, hyperventilation is “breathing fast,” or overbreathing, says Stephen J. Harrison, M.D., senior emergency medical resident at the Medical Center of Delaware in Wilmington.
“Anxiety is a common cause,” says Gabe Mirkin, M.D., a sports medicine expert from Silver Spring, Maryland, and an associate clinical professor at Georgetown University School of Medicine. “When some people are frightened, they breathe rapidly and deeply, even though they don’t need the extra oxygen. This causes them to breathe out a large amount of carbon dioxide, and excessive loss of carbon dioxide causes the blood to become alkaline. This in turn causes the symptoms
of a panic attack.”
Episodes of hyperventilation can last for hours but typically just 20 to 30 minutes. But to the heavy-breathing sufferer it can seem like hours.
Of course Varner was relieved to learn he had not suffered a heart attack. But his experience with hyperventilation was just beginning—repeat attacks are not uncommon. But Varner learned there are things you can do to stop attacks and to prevent them.
MEDICAL ALERT
Let Your Doctor Diagnose
One moment you’re breathing normally—then suddenly you are breathing fast—out of control—your heart is pounding, your fingers are tingling, and your palms are sweating. You feel as if you’re going to die, but in all probability you’ll live to pay next year’s taxes.
Hyperventilation, in most cases, is caused by anxiety. But if you’ve never experienced hyperventilation before, “you probably should be seen by a doctor,” says Stephen J. Harrison, M.D.
Though it is uncommon, hyperventilation could be connected to a lung disease, a blood infection, pneumonia—even poisoning. Also, it’s possible that what feels like a heart attack is a heart attack.
Of course, it’s probably nothing that serious—but leave the official diagnosis to a doctor.
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Breathe into a paper bag. This has long been the primary treatment for hyperventilation. The theory is that rebreathing into a paper bag will allow the person to replace the carbon dioxide “blown off” while hyperventilating.
“Blowing into a paper bag is fine,” Dr. Harrison says, “if you’ve hyperventilated before, been evaluated by a doctor, and are sure there is nothing seriously wrong.” Most people who hyperventilate meet that criteria, but a few may have more severe problems. (See “Let Your Doctor Diagnose” on the opposite page.)
Varner says using a paper bag not only helped him halt attacks, but it may have prevented some, too. “When I was battling this problem daily, I would carry a paper bag with me all the time,” he says. “And just knowing I had that sack with me was a big help.”
Sit down, be calm, and relax. You need to slow your breathing, says Dr. Mirkin. The more tense you are, the faster you’ll breathe.
Practice breathing naturally. Don’t take exaggerated breaths and don’t take very shallow breaths—take normal breaths. That’s one breath every 6 seconds or ten breaths a minute. Do this twice a day, 10 minutes per session, Dr. Mirkin advises.
Think beyond yourself. “Once I had that first hyperventilation experience, I became consumed with thoughts of having another one. And I did have several more,” Varner says. So while you want to focus on your breathing in the practice sessions, Dr. Mirkin suggests you don’t want to spend all your time thinking about your breathing and the possibility of hyperventilating.
“After all,” says Dr. Harrison, “breathing is a natural thing.”
Exercise. “It decreases anxiety and helps people cope better,” Dr. Harrison says. “Especially if you get your heart rate up.” And when exercising, breathing a little faster is fine.
Avoid uncomfortable situations. For Varner, that means not trapping himself in a crowd where he has to sit or stand still for long periods of time. Identify situations in your life that trigger hyperventilation and eliminate or reduce them. “If your fear of black cats, for example, makes you hyperventilate, then steer clear of black cats,” says Dr. Mirkin.
Cut caffeine. It’s a stimulant, and therefore, a potential trigger for hyperventilation, says Dr. Harrison. Watch out for coffee, tea, colas, and chocolate.
Don’t smoke. Nicotine is also a stimulant.
PANEL OF ADVISERS
Stephen J. Harrison, M.D., is senior emergency medical resident at the Medical Center of Delaware in Wilmington.
Gabe Mirkin, M.D., is in private practice at the Sportsmedicine Institute in Silver Spring, Maryland. He is also associate clinical professor of pediatrics at Georgetown University School of Medicine in Washington, D.C. He is the author of several sports medicine books, including Dr. Gabe Mirkin’s Fitness Clinic, and is a syndicated newspaper columnist and radio broadcaster.