Breathing retraining in the treatment of panic disorder: Efficacy, caveats
and indications. .
AUTHOR: Taylor,-Steven
SOURCE: Scandinavian-Journal-of-Behaviour-Therapy.
2001; Vol 30(2): 49-56.
Full Text: EBSCO Online
PUBLISHER: Norway: Scandinavian Univ Press.
ISSN: 0284-5717
PUBLICATION YEAR: 2001
ABSTRACT: Breathing retraining is commonly used
in the treatment of panic disorder. Although several
studies suggest that this intervention is effective
in reducing panic frequency, concerns have been raised
about its routine use. For example, recent research
suggests that hyperventilation plays a limited role in
producing panic attacks. This suggests that breathing
retraining may only be useful for a minority of
patients, for whom hyperventilation (or chest breathing)
plays a role in producing panic symptoms. A
further concern is that breathing retraining may
be counterproductive to the extent that it prevents patients
from learning that their catastrophic beliefs are
unfounded. This article reviews the evidence for the efficacy
of breathing retraining and considers the caveats
and indications for its use. It is concluded that breathing
retraining can play a useful role in the treatment
of panic disorder, although clinicians must exercise care to
ensure that it is not misused by patients as a means
of escaping or avoiding feared sensations.
The treatment of panic disorder: A comparative study between breathing
retraining and cognitive behavioral therapy.
AUTHOR: Berger,-Beth-Creager
SOURCE: Dissertation-Abstracts-International:-Section-B:-The-Sciences-and-Engineering.
2001 Mar;
Vol 61(8-B): 4390.
ISSN: 0419-4217
PUBLICATION YEAR: 2001
UMI ORDER NUMBER: AAI9984306
ABSTRACT: Cognitive Behavioral Therapy (CBT) is
a widely used and highly effective treatment for
panic disorder. It consists of different components
and breathing retraining (BR) is often included. It is not
clear what mechanism of panic is affected when panic
symptoms decrease. There has been an increase in
studies over the past ten years looking at the respiratory
component of panic. It is thought that BR may be
effective in the treatment of panic if the respiratory
aspect is a primary element in panic. Few studies have
looked solely at breathing retraining in the treatment
of panic. A treatment outcome study was conducted
to assess if BR may be as effective as CBT in decreasing
the frequency and severity of panic symptoms.
Ten people with panic disorder were randomly assigned
to CBT without BR and 11 were randomly
assigned to a BR group. All participants kept a
panic attack journal 4 weeks prior to starting treatment
through 4 weeks after treatment. The BR group included
six 30 to 60 minute sessions of breathing
retraining. The CBT group followed a modified version
of Craske, Barlow, and Meadows protocol
(1994) which consisted of ten 45 to 90 minute sessions.
Results show that BR appears as effective as
CBT in the treatment of panic disorder. There were
no significant pre to post differences in the severity or
frequency of panic attacks between the two groups.
It is felt that the respiratory component is more
essential in panic than has been acknowledged in
the past. Because breathing retraining can be taught more
rapidly than cognitive behavioral therapy and therefore
provide relief sooner, it can be a useful tool in the
treatment of panic.
Efficacy of usual antidepressant dosing regimens of fluoxetine in panic
disorder: Randomised, placebo-controlled trial.
AUTHOR: Michelson,-David; Allgulander,-Christer;
Dantendorfer,-Karl; Knezevic,-Aleksandar;
Maierhofer,-Dagmar; Micev,-Vitomar; Paunovic,-Vladimir-R;
Timotijevic,-Ivana; Sarkar,-Neena;
Skoglund,-Lennart; Pemberton,-S-Craig
SOURCE: British-Journal-of-Psychiatry. 2001 Dec;
Vol 179: 514-518.
Full Text: HighWire
PUBLISHER: England: Royal Coll of Psychiatrists.
ISSN: 0007-1250
PUBLICATION YEAR: 2001
ABSTRACT: Assessed the efficacy of the usual antidepressant
dose of fluoxetine in treating full panic
attacks. 180 patients with panic disorder were randomised
to placebo or to fluoxetine initiated at 10 mg
daily for 1 week and then increased to 20 mg daily.
The trial lasted 12 weeks, but after 6 weeks patients
who had failed to achieve a satisfactory response
were eligible for dose escalation to a maximum of 60 mg
of fluoxetine daily. Fluoxetine was associated with
a statistically significantly greater proportion of
panic-free patients compared with placebo after
6 weeks and at end-point. Fluoxetine at a dose of 20 mg
daily is safe and efficacious in reducing symptoms
of panic disorder. Patients who fail to obtain a
satisfactory response at 20 mg daily may benefit
from further dose increases.
Prevention of panic.
AUTHOR: Gardenswartz,-Cara-Ann
SOURCE: Dissertation-Abstracts-International:-Section-B:-The-Sciences-and-Engineering.
2001 Aug;
Vol 62(2-B): 1077.
ISSN: 0419-4217
PUBLICATION YEAR: 2001
UMI ORDER NUMBER: AAI3005975
ABSTRACT: Over the past 30 years, effective psychological
treatments for anxiety disorders have been
developed and empirically tested. In particular,
cognitive-behavioral treatment of panic disorder has been
shown to be both statistically and clinically significant.
However, little research has looked at primary or
secondary prevention of panic disorder. The goal
of this study was to use our knowledge about effective
treatment strategies for panic disorder to implement
and empirically test a prevention program designed to
diminish panic symptomatology and prevent panic
disorder. Participants who had a recent panic attack
were randomly assigned to either a one-day prevention
workshop group or a waitlist control group.
Participants were followed for six months post-workshop
in order to determine whether the workshop
was effective in decreasing the anxiety and panic
symptomatology and/or panic disorder during this period.
Results indicated that the prevention workshop was
successful in reducing both panic disorder diagnoses,
and frequency and intensity of panic attacks. Furthermore,
the workshop decreased social avoidance,
and avoidance in the participants.
Prospective evaluation of the efficacy of a brief cognitive-behavioral
intervention on the
development of panic disorder and anxiety in a high-risk, nonclinical
college population.
AUTHOR: Abplanalp,-Bart-Solomon
SOURCE: Dissertation-Abstracts-International:-Section-B:-The-Sciences-and-Engineering.
2001 Sep;
Vol 62(3-B): 1562.
ISSN: 0419-4217
PUBLICATION YEAR: 2001
UMI ORDER NUMBER: AAI3008262
ABSTRACT: The present study sought to determine
the effectiveness of a brief cognitive-behavioral
intervention (called Panic Prevention Training)
in lowering anxiety sensitivity (a proposed risk factor in the
development of panic) and subsequently reducing
the risk of developing panic attacks and anxiety-related
symptomatology. The short-term effects of the intervention
in lowering anxiety sensitivity (AS) were
examined through a battery of self-report measures.
In addition, participants inhaled a 35% CO2/65% O
2 gas mixture designed to generate intense physiological
sensations. The long-term effects of the
intervention on the incidence of panic attacks and
panic-related apprehension were then assessed with a
follow-up interview one year after completion of
the initial phase of the study. Study participants were 405
university students with elevated anxiety sensitivity
(high AS). Participants were assigned to either (1) the
Panic Prevention Training (PPT) group or (2) a Non-Specific
Training (NST) group. The purpose of the
PPT group was to provide detailed information regarding
panic anxiety and to habituate participants' fears
through cognitive restructuring and repeated exposure
exercises. The NST condition was designed to
control for more general factors associated with
participation in a group setting. The intervention
demonstrated significant short-term effects with
PPT participants showing a reduction in both the specific
factors related to anxiety sensitivity and one general
measure of psychopathology and mood. In addition,
the intervention was successful at reducing fear
and self-reported panic in response to the CO2. At
follow-up, the groups did not differ in either panic
attack or panic disorder incidence. However, among
those participants who did experience a panic attack
during the follow-up period, the PPT group showed
significantly lower panic-related apprehension compared
to the NST group. The current study provides
support for the short-term effects of a cognitive-behavioral
intervention at lowering anxiety sensitivity and
extends the work of previous studies in showing
that these effects are maintained at one-year follow-up.
Although the intervention failed to affect the incidence
rate for panic attacks or panic disorder, it was
successful at significantly lowering panic-related
apprehension. The study provides preliminary support for
the effectiveness of Panic Prevention Training to
reduce both proximal and distal risk factors in the
development of panic disorder.
Reboxetine, a selective norepinephrine reuptake inhibitor, is an effective
and well-tolerated treatment for panic disorder.
AUTHOR: Versiani,-Marcio; Cassano,-Giovanni; Perugi,-Giulio;
Benedetti,-Alessandra; Mastalli,-Luigia;
Nardi,-Antonio; Savino,-Mario
SOURCE: Journal-of-Clinical-Psychiatry. 2002 Jan;
Vol 63(1): 31-37.
PUBLISHER: US: Physicians Postgraduate Press.
ISSN: 0160-6689
PUBLICATION YEAR: 2002
ABSTRACT: Tricyclic antidepressants and selective
serotonin reuptake inhibitors (SSRIs) as well as
benzodiazepines have been shown to be effective
for the treatment of panic disorder. The aim of this study
was to determine the efficacy and tolerability of
reboxetine, a novel selective norepinephrine reuptake
inhibitor, in patients with panic disorder with
and without agoraphobia. 82 patients (aged 18-65 years)
with Mental Disorders-III-Revised (DSM-III-R) panic
disorder, with or without agoraphobia, were
randomly assigned to receive 6 to 8 mg/day of reboxetine
(42 patients) or placebo (40 patients) for 8
weeks in this placebo-controlled, parallel-group,
double-blind clinical trial. Of the 82 patients enrolled in
the trial, 75 were considered in the analysis (37
patients in the reboxetine group and 38 patients in the
placebo group). At last assessment, there was a
significant reduction in the mean number of panic attacks
(range, 9.3-1.2) and phobic symptoms (range, 8.1-3.2)
in the reboxetine group compared with the
placebo group (ranges, 8.5-5.8 and 7.7-5.2, respectively).
Conclusions suggest reboxetine was effective
and well tolerated in the treatment of panic disorder.
Early-onset fearful panic attack: A possible prodrome of early-onset
severe psychopathology.
AUTHOR: Goodwin,-Renee-D; Hamilton,-Steven-P
SOURCE: Comprehensive-Psychiatry. 2002 Jan-Feb;
Vol 43(1): 22-27.
PUBLISHER: US: WB Saunders.
ISSN: 0010-440X
PUBLICATION YEAR: 2002
ABSTRACT: To determine whether early-onset panic
attack with fear at onset represents a possible
prodrome of early-onset severe psychopathology,
we drew data from the National Comorbidity Survey
(N=8,098), a probability sample drawn from respondents
aged 18-54 yrs in the US. Multivariate logistic
regression analyses were used to determine differences
in age of onset of comorbid mental disorders,
familial psychopathology, and lethality of suicide
attempts between those with early-onset panic attacks
with fear at onset compared with individuals with
panic attacks that do not meet this criteria. Logistic
regression analyses revealed that respondents with
early-onset panic attack with fear at onset had
significantly earlier onset of almost every comorbid
mental disorder, higher rates of familial
psychopathology, and increased risk and lethality
of suicide attempt compared with those with other panic
attacks. These findings provide preliminary evidence
to suggest that early-onset fearful panic attack may
be a marker of risk of a lengthy course of severe
psychopathology, which is predicted by familial mental
illness, and is characterized by early onset and
increased risk of serious suicidal behavior.
Hyperventilation challenge test in panic disorder and depression with
panic attacks.
AUTHOR: Nardi,-Antonio-E; Valenca,-Alexandre-M;
Nascimento,-Isabella; Zin,-Walter-A
SOURCE: Psychiatry-Research. 2001 Dec; Vol 105(1-2):
57-65.
Full Text: ScienceDirect (tm)
PUBLISHER: US: Elsevier Scientific.
ISSN: 0165-1781
PUBLICATION YEAR: 2001
ABSTRACT: Determined whether panic disorder (PD)
patients, major depressive patients without panic
attacks (MD) and major depressive patients with
panic attacks (MDP) respond similarly to
hyperventilation challenge tests. Ss were 35 PD
patients, 33 MDP patients, 27 MD patients and 30
normal volunteers with no family history of anxiety
or mood disorder. The patients had not been treated
with psychotropic drugs for at least 1 week. They
were induced to hyperventilate (30 breaths/min) for 4
min, and anxiety was assessed before and after the
test. A total of 16 (45.7%) PD patients, 12 (36.4%)
MDP patients, 4 (11.1%) MD patients, and 2 (6.7%)
normal volunteers had a panic attack after
hyperventilating. The PD and MDP patients were significantly
more responsive to hyperventilation than the
MD patients and the normal volunteers. The MD patients
had a significantly lower heart-rate response to
the test than all the other groups. There is growing
evidence that PD patients are more sensitive to the
vasoconstrictive effects on basilar arterial blood
flow caused by hyperventilation-induced hypocapnia than
are comparison subjects. Data suggest that there
is an association between panic attacks and
hyperreactivity to an acute hyperventilation challenge
test.