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Vlemincx E, Van Diest I, Van den Bergh O. Imposing respiratory variability patterns. Appl Psychophysiol Biofeedback 2013; 37:153-60. [PMID: 22419514 DOI: 10.1007/s10484-012-9187-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
To ensure respiratory stability and flexibility, healthy breathing shows balanced variability consisting of considerable correlated variability (parameters of each breath are correlated to parameters of adjoining breaths) and some random variability. Sighing resets this balance when respiration lacks variability or becomes excessively irregular. The present study aimed to investigate the effect of imposed patterns of breathing variability on sighing and self-reported (dis)comfort. Spontaneous breathing was compared to imposed non-variable, correlated and random breathing. Results show that executing imposed breathing is difficult, demanding, and induces tension. Sigh occurrence following spontaneous and imposed breathing patterns could be predicted by self-reported discomfort and increased random variability. However, including non-variable, correlated and random breathing patterns only, the effects of self-reported discomfort on sigh occurrence override the effects of altered breathing variability.
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Affiliation(s)
- Elke Vlemincx
- Department of Psychology, Research Group on Health Psychology, University of Leuven, Leuven, Belgium.
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52
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Vlemincx E, Abelson JL, Lehrer PM, Davenport PW, Van Diest I, Van den Bergh O. Respiratory variability and sighing: a psychophysiological reset model. Biol Psychol 2012; 93:24-32. [PMID: 23261937 DOI: 10.1016/j.biopsycho.2012.12.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 11/29/2012] [Accepted: 12/02/2012] [Indexed: 11/30/2022]
Abstract
Whereas respiratory psychophysiological research has mainly studied respiratory time and volume, variability in these parameters has been largely disregarded, even though it may provide important information about respiratory regulation. The present paper reviews the literature on respiratory variability and elaborates on the importance of assessing various components of respiratory variability when studying the interrelationships between emotions and breathing. A model is proposed that predicts specific action tendencies related to emotions to disturb the balance between various respiratory variability components depending on valence by arousal and control dimensions. The central focus of the paper is sighing. The causes and consequences of sighing are reviewed and integrated in the proposed model in which sighing is hypothesized to function as a resetter in the regulation of both breathing and emotions, because it restores a balance in respiratory variability fractions and causes relief.
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Affiliation(s)
- Elke Vlemincx
- Research Group on Health Psychology, Department of Psychology, University of Leuven, Belgium.
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53
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Abstract
OBJECTIVES AND METHODS Self-report studies have shown an association between music performance anxiety (MPA) and hyperventilation complaints. However, hyperventilation was never assessed physiologically in MPA. This study investigated the self-reported affective experience, self-reported physiological symptoms, and cardiorespiratory variables including partial pressure of end-tidal CO(2) (Petco(2)), which is an indicator for hyperventilation, in 67 music students before a private and a public performance. The response coherence between these response domains was also investigated. RESULTS From the private to the public session, the intensity of all self-report variables increased (all p values < .001). As predicted, the higher the musician's usual MPA level, the larger were these increases (p values < .10). With the exception of Petco(2), the main cardiorespiratory variables also increased from the private to the public session (p values < .05). These increases were not modulated by the usual MPA level (p values > .10). Petco(2) showed a unique response pattern reflected by an MPA-by-session interaction (p < .01): it increased from the private to the public session for musicians with low MPA levels and decreased for musicians with high MPA levels. Self-reported physiological symptoms were related to the self-reported affective experience (p values < .05) rather than to physiological measures (p values > .17). CONCLUSIONS These findings show for the first time how respiration is stimulated before a public performance in music students with different MPA levels. The hypothesis of a hyperventilation tendency in high-performance-anxious musicians is supported. The response coherence between physiological symptoms and physiological activation is weak.
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54
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Freire RC, Nardi AE. Panic disorder and the respiratory system: clinical subtype and challenge tests. BRAZILIAN JOURNAL OF PSYCHIATRY 2012. [DOI: 10.1016/s1516-4446(12)70053-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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55
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A sigh following sustained attention and mental stress: effects on respiratory variability. Physiol Behav 2012; 107:1-6. [PMID: 22634279 DOI: 10.1016/j.physbeh.2012.05.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 05/07/2012] [Accepted: 05/16/2012] [Indexed: 11/20/2022]
Abstract
Normal breathing consists of considerable correlated variability (parameters of subsequent breaths are correlated) and some random variability. Emotional and attentive states alter normal breathing variability, which can be restored by a sigh. The present study aimed to investigate the effects of mental arithmetic and sustained attention on respiratory variability. In addition, the effect of a spontaneous sigh following both conditions was examined, compared to an instructed sigh and a control maneuver. Mental arithmetic and sustained attention were characterized by decreased correlated and total breathing variability, respectively. A spontaneous sigh restored correlated variability. An instructed sigh restored correlated variability following mental arithmetic, and increased total variability following sustained attention. These results suggest that a spontaneous sigh and an instructed sigh, when physiologically appropriate, restore respiratory variability influenced by stress or attention.
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56
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Ashwin C, Holas P, Broadhurst S, Kokoszka A, Georgiou GA, Fox E. Enhanced anger superiority effect in generalized anxiety disorder and panic disorder. J Anxiety Disord 2012; 26:329-36. [PMID: 22196167 PMCID: PMC3277887 DOI: 10.1016/j.janxdis.2011.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 11/14/2011] [Accepted: 11/20/2011] [Indexed: 11/11/2022]
Abstract
People are typically faster and more accurate to detect angry compared to happy faces, which is known as the anger superiority effect. Many cognitive models of anxiety suggest anxiety disorders involve attentional biases towards threat, although the nature of these biases remains unclear. The present study used a Face-in-the-Crowd task to investigate the anger superiority effect in a control group and patients diagnosed with either generalized anxiety disorder (GAD) or panic disorder (PD). The main finding was that both anxiety groups showed an enhanced anger superiority effect compared to controls, which is consistent with key theories of anxiety. Furthermore, both anxiety groups showed a differential pattern of enhanced bias towards threat depending on the crowd in the displays. The different attentional bias patterns between the GAD and PD groups may be related to the diverse symptoms in these disorders. These findings have implications for the diagnosis and treatment of anxiety.
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Affiliation(s)
- Chris Ashwin
- Department of Psychology, University of Essex, Wivenhoe Park, Colchester, UK.
| | - Pawel Holas
- II Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Shanna Broadhurst
- Department of Psychology, University of Essex, Wivenhoe Park, Colchester, UK
| | - Andrzej Kokoszka
- II Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | | | - Elaine Fox
- Department of Psychology, University of Essex, Wivenhoe Park, Colchester, UK,Corresponding author. Tel.: +44 01225 383502; fax: +44 01225 386752
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Bell IR, Koithan M, Pincus D. Methodological implications of nonlinear dynamical systems models for whole systems of complementary and alternative medicine. ACTA ACUST UNITED AC 2012; 19 Suppl 1:15-21. [PMID: 22327547 DOI: 10.1159/000335183] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This paper focuses on the worldview hypotheses and research design approaches from nonlinear dynamical complex systems (NDS) science that can inform future studies of whole systems of complementary and alternative medicine (WS-CAM), e.g., Ayurveda, traditional Chinese medicine, and homeopathy. The worldview hypotheses that underlie NDS and WS-CAM (contextual, organismic, interactive-integrative - Pepper, 1942) overlap with each other, but differ fundamentally from those of biomedicine (formistic, mechanistic). Differing views on the nature of causality itself lead to different types of study designs. Biomedical efficacy studies assume a simple direct mechanistic cause-effect relationship between a specific intervention and a specific bodily outcome, an assumption less relevant to WS-CAM outcomes. WS-CAM practitioners do not necessarily treat a symptom directly. Rather, they intervene to modulate an intrinsic central imbalance of the person as a system and to create a more favorable environmental context for the emergence of health, e.g., with dietary changes compatible with the constitutional type. The rebalancing of the system thereby fosters the emergence of indirect, diffuse, complex effects throughout the person and the person's interactions with his/her environment. NDS theory-driven study designs thus have the potential for greater external and model validity than biomedically driven efficacy studies (e.g., clinical trials) for evaluating the indirect effects of WS-CAM practices. Potential applications of NDS analytic techniques to WS-CAM include characterizing different constitutional types and documenting the evolution and dynamics of whole-person healing and well-being over time. Furthermore, NDS provides models and methods for examining interactions across organizational scales, from genomic/proteomic/metabolomic networks to individuals and social groups.
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Affiliation(s)
- Iris R Bell
- Department of Family and Community Medicine, The University of Arizona, Tucson, AZ 85719-5052, USA.
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58
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Wuyts R, Vlemincx E, Bogaerts K, Van Diest I, Van den Bergh O. Sigh rate and respiratory variability during normal breathing and the role of negative affectivity. Int J Psychophysiol 2011; 82:175-9. [PMID: 21872623 DOI: 10.1016/j.ijpsycho.2011.07.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 06/30/2011] [Accepted: 07/11/2011] [Indexed: 10/17/2022]
Abstract
Spontaneous breathing was measured in healthy persons scoring either high (N=45) or low (N=30) on trait negative affectivity (NA), during a 10 min period of quiet sitting using the LifeShirt System®. Sighing and respiratory variability before and after sighs were assessed. Total respiratory variability of minute ventilation was indexed by the coefficient of variation and structured (correlated) variability was quantified by the autocorrelation. Total variability was higher before a sigh than before a non-sigh, without concomitant differences in structured variability, suggesting more random variability before a sigh. After a sigh, correlated variability increased whereas it remained the same after a non-sigh. Thus sighing acted as a resetter of the respiratory system. However, when comparing the low and the high NA group, this pattern was specific for high NA individuals. We conclude that it is important to take into account individual difference variables when studying the psychophysiological functions of sighing.
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Affiliation(s)
- Ruth Wuyts
- Research Group on Health Psychology, University of Leuven, Belgium
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59
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Vlemincx E, Taelman J, De Peuter S, Van Diest I, Van den Bergh O. Sigh rate and respiratory variability during mental load and sustained attention. Psychophysiology 2011; 48:117-20. [PMID: 20536901 DOI: 10.1111/j.1469-8986.2010.01043.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Spontaneous breathing consists of substantial correlated variability: Parameters characterizing a breath are correlated with parameters characterizing previous and future breaths. On the basis of dynamic system theory, negative emotion states are predicted to reduce correlated variability whereas sustained attention is expected to reduce total respiratory variability. Both are predicted to evoke sighing. To test this, respiratory variability and sighing were assessed during a baseline, stressful mental arithmetic task, nonstressful sustained attention task, and recovery in between tasks. For respiration rate (excluding sighs), reduced total variability was found during the attention task, whereas correlated variation was reduced during mental load. Sigh rate increased during mental load and during recovery from the attention task. It is concluded that mental load and task-related attention show specific patterns in respiratory variability and sigh rate.
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Affiliation(s)
- Elke Vlemincx
- Research Group on Health Psychology, Department of Psychology, University of Leuven, Leuven, Belgium
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60
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Effects of Breathing Training on Voluntary Hypo- and Hyperventilation in Patients with Panic Disorder and Episodic Anxiety. Appl Psychophysiol Biofeedback 2011; 36:81-91. [DOI: 10.1007/s10484-011-9150-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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61
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Doberenz S, Roth WT, Wollburg E, Breuninger C, Kim S. Twenty-four hour skin conductance in panic disorder. J Psychiatr Res 2010; 44:1137-47. [PMID: 20537349 PMCID: PMC2937198 DOI: 10.1016/j.jpsychires.2010.04.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Revised: 03/31/2010] [Accepted: 04/08/2010] [Indexed: 10/19/2022]
Abstract
Skin conductance, physical activity, ambient temperature and mood were recorded for 24 h in 22 panic disorder (PD) patients and 29 healthy controls. During the day, subjects performed standardized relaxation tests (ARTs). We hypothesized that tonically elevated anticipatory anxiety in PD during waking and sleeping would appear as elevated skin conductance level (SCL) and greater skin conductance (SC) variability. Mean SCL was higher during both usual waking activities and sleeping in PD, but not during the ARTs. Group SC variability differences did not reach significance, perhaps because of variance unrelated to anxiety. Analyses indicated that in the PD group, antidepressant medication reduced mean SCL whereas state anxiety had the opposite effect during the day. Depressive symptoms reported during the day were related to elevated mean SCL on the night of the recording. The rate and extent of SCL deactivation over the night was equal in the two groups. However, PD patients had more frequent interruptions of deactivation that could have arisen from conditioned arousal in response to threat cues during sleep.
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62
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Annerbrink K, Olsson M, Hedner J, Eriksson E. Acute and chronic treatment with serotonin reuptake inhibitors exert opposite effects on respiration in rats: possible implications for panic disorder. J Psychopharmacol 2010; 24:1793-801. [PMID: 19825902 DOI: 10.1177/0269881109106908] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prompted by the suggested importance of respiration for the pathophysiology of panic disorder, we studied the influence of serotonin reuptake inhibitors (SRIs) as well as other serotonin-modulating compounds on respiration in freely moving rats. The effect on respiration after acute administration of compounds enhancing synaptic levels of serotonin, that is, the serotonin reuptake inhibitors paroxetine and fluoxetine, the serotonin-releasing agents m-chlorophenylpiperazine and d-fenfluramine, and the selective 5-HT1A antagonist WAY-100635, were investigated. All serotonin-releasing substances decreased respiratory rate in unrestrained, awake animals, suggesting the influence of serotonin on respiratory rate under these conditions to be mainly inhibitory. In line with a previous study, rats administered fluoxetine for 23 days or more, on the other hand, displayed an enhanced respiratory rate. The results reinforce the assumption that the effect of subchronic administration of a serotonin reuptake inhibitor on certain serotonin-regulated parameters may be opposite to that obtained after acute administration. We suggest that our observations may be of relevance for the fact that acute administration of SRIs, d-fenfluramine, or m-chlorophenylpiperazine often is anxiogenic in panic disorder patients, and that weeks of administration of an SRI leads to a very effective prevention of panic.
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Affiliation(s)
- Kristina Annerbrink
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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63
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Dager SR. The vexing role of baseline: Implications for neuroimaging studies of panic disorder. Int J Psychophysiol 2010; 78:20-6. [DOI: 10.1016/j.ijpsycho.2010.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 01/09/2010] [Accepted: 01/12/2010] [Indexed: 11/29/2022]
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64
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Pfaltz MC, Grossman P, Michael T, Margraf J, Wilhelm FH. Physical activity and respiratory behavior in daily life of patients with panic disorder and healthy controls. Int J Psychophysiol 2010; 78:42-9. [DOI: 10.1016/j.ijpsycho.2010.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 04/28/2010] [Accepted: 05/05/2010] [Indexed: 10/19/2022]
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65
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Temporal stability and coherence of anxiety, dyspnea, and physiological variables in panic disorder. Biol Psychol 2010; 85:226-32. [PMID: 20637257 DOI: 10.1016/j.biopsycho.2010.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 07/06/2010] [Indexed: 11/21/2022]
Abstract
Twenty-five panic disorder (PD) patients, 19 social phobics (SP), and 20 healthy controls (HC) sat quietly for 15 min, rating their anxiety and dyspnea every 30s while respiratory, cardiovascular, and electrodermal responses were recorded. No panic attacks were reported. For self-reported anxiety and dyspnea, within-subject variability over time was higher in PD than in SP or HC. In PD within-subject correlations across 30-s epochs were significant for (a) self-reported anxiety versus dyspnea, end-tidal pCO2, minute volume, duty cycle, skin conductance level, and interbeat interval, and for (b) dyspnea versus end-tidal pCO2, minute volume, tidal volume, and inspiratory flow rate. Several positive or negative correlations were greater in PD than in other groups. Thus in PD, experienced anxiety and dyspnea are temporally unstable but are correlated with each other and with fluctuations in respiratory and autonomic variables, even in the absence of panic attacks.
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66
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Delgado LC, Guerra P, Perakakis P, Vera MN, Reyes del Paso G, Vila J. Treating chronic worry: Psychological and physiological effects of a training programme based on mindfulness. Behav Res Ther 2010; 48:873-82. [PMID: 20541180 DOI: 10.1016/j.brat.2010.05.012] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 05/06/2010] [Accepted: 05/18/2010] [Indexed: 10/19/2022]
Abstract
The present study examines psychological and physiological indices of emotional regulation in non-clinical high worriers after a mindfulness-based training programme aimed at reducing worry. Thirty-six female university students with high Penn State Worry Questionnaire scores were split into two equal intervention groups: (a) mindfulness, and (b) progressive muscle relaxation plus self-instruction to postpone worrying to a specific time of the day. Assessment included clinical questionnaires, daily self-report of number/duration of worry episodes and indices of emotional meta-cognition. A set of somatic and autonomic measures was recorded (a) during resting, mindfulness/relaxation and worrying periods, and (b) during cued and non-cued affective modulation of defence reactions (cardiac defence and eye-blink startle). Both groups showed equal post-treatment improvement in the clinical and daily self-report measures. However, mindfulness participants reported better emotional meta-cognition (emotional comprehension) and showed improved indices of somatic and autonomic regulation (reduced breathing pattern and increased vagal reactivity during evocation of cardiac defense). These findings suggest that mindfulness reduces chronic worry by promoting emotional and physiological regulatory mechanisms contrary to those maintaining chronic worry.
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Affiliation(s)
- Luis Carlos Delgado
- Department of Personality, Assessment and Psychological Treatment, University of Granada, Spain
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67
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Ritz T, Meuret AE, Ayala ES. The psychophysiology of blood-injection-injury phobia: looking beyond the diphasic response paradigm. Int J Psychophysiol 2010; 78:50-67. [PMID: 20576505 DOI: 10.1016/j.ijpsycho.2010.05.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 04/29/2010] [Accepted: 05/20/2010] [Indexed: 10/19/2022]
Abstract
Blood-injection-injury (BII) phobia is an anxiety disorder that may be accompanied by vasovagal fainting during confrontation with the feared stimuli. The underlying pattern of autonomic regulation has been characterized as a diphasic response, with initial increases in heart rate and blood pressure that are typical of a fight-flight response, and subsequent drops in blood pressure and/or heart rate that may precipitate vasovagal fainting. Tensing skeletal muscles of the arms, legs, and trunk (applied tension) has been proposed as a technique to cope with this dysregulation. This review critically examines the empirical basis for the diphasic response and its treatment by applied tension in BII phobia. An alternative perspective on the psychophysiology of BII phobia and vasovagal fainting is offered by focusing on hypocapnia that leads to cerebral blood flow reductions, a perspective supported by research on neurocardiogenic and orthostatically-induced syncope. The evidence may indicate a role for respiration-focused coping techniques in BII phobia.
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Affiliation(s)
- Thomas Ritz
- Department of Psychology, Southern Methodist University, P.O. Box 750442, Dallas, TX 75275-0442, USA.
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68
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Vlemincx E, Taelman J, Van Diest I, Van den Bergh O. Take a deep breath: the relief effect of spontaneous and instructed sighs. Physiol Behav 2010; 101:67-73. [PMID: 20417649 DOI: 10.1016/j.physbeh.2010.04.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 04/07/2010] [Accepted: 04/15/2010] [Indexed: 11/16/2022]
Abstract
Spontaneous sighing is related to subjective relief of negative emotional states. Whether this also applies to instructed sighing is not known. The present study aimed to investigate sEMG and respiratory variability (1) during recovery from mental stress with and without an instructed sigh; (2) before and after spontaneous sighs throughout the experiment. A spontaneous sigh was preceded by increasing sEMG and increasing random respiratory variability, and followed by decreasing sEMG and increased structured correlated respiratory variability. Following an instructed sigh, a smaller reduction in sEMG and an increase in random respiratory variability during recovery from mental stress were observed. Thus, a spontaneous sigh seemed to induce relief. An instructed sigh appeared to inhibit recovery from mental stress.
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Affiliation(s)
- Elke Vlemincx
- Research Group on Health Psychology, Department of Psychology, University of Leuven, Belgium.
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69
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Abelson JL, Khan S, Giardino N. HPA axis, respiration and the airways in stress--a review in search of intersections. Biol Psychol 2010; 84:57-65. [PMID: 20144683 DOI: 10.1016/j.biopsycho.2010.01.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 01/27/2010] [Accepted: 01/31/2010] [Indexed: 10/19/2022]
Abstract
Given clear connections between respiratory distress and subjective anxiety, it is not surprising that respiratory psychophysiologists have been interested in the psychobiology of anxiety. Given parallel links between anxiety and stress, it is not surprising that the hypothalamic-pituitary adrenal (HPA) stress system has also been a focus in anxiety research. However, despite extensive work in respiratory psychophysiology and stress neuroendocrinology--and evidence that these systems are jointly dysregulated in anxiety disorders--direct studies of their interactions are rare. This paper reviews evidence for scientific intersections, providing an overview of the HPA axis, its psychobiology, and shared neural substrates for HPA and respiratory control. We examine HPA hormone effects on respiration, immune/inflammatory mediators, and lung maturation. We also examine respiratory/dyspnea effects on HPA axis. There are clear points of intersection in the neuroscience of respiration and stress. Given the importance of both systems to an organism's ability to survive and adapt in challenging and changing environments, further study of their interactions is needed.
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Affiliation(s)
- James L Abelson
- Stress and Anxiety Research Group, Department of Psychiatry Trauma, University of Michigan, Ann Arbor, MI 48109, USA.
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70
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Blechert J, Wilhelm FH, Meuret AE, Wilhelm EM, Roth WT. Respiratory, autonomic, and experiential responses to repeated inhalations of 20% CO₂ enriched air in panic disorder, social phobia, and healthy controls. Biol Psychol 2010; 84:104-11. [PMID: 20064582 DOI: 10.1016/j.biopsycho.2010.01.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Revised: 12/02/2009] [Accepted: 01/03/2010] [Indexed: 10/20/2022]
Abstract
Inhalation of carbon dioxide (CO₂) enriched air triggers anxiety in panic disorder (PD) patients, which is often interpreted as a sign of biological vulnerability. However, most studies have not measured respiration in these tasks. We compared patients with PD (n=20) and social phobia (SP, n=19) to healthy controls (n=18) during eight inhalations of 20% CO₂, preceded and followed by two inhalations of room air, while continuously measuring subjective anxiety and dyspnea as well as autonomic and respiratory variables. PD patients showed increased reactivity and delayed recovery during CO₂ inhalations for most measures. Unlike both other groups, the PD group's tidal volume responses did not habituate across CO₂ inhalations. However, PD patients did not differ from SP patients on most other measures, supporting a continuum model of CO₂ sensitivity across anxiety disorders. Both patient groups showed continued reactivity during the last air inhalations, which is unlikely to be due to a biological sensitivity.
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Affiliation(s)
- Jens Blechert
- Department of Clinical Psychology and Psychotherapy, Institute for Psychology, University of Freiburg, Germany
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71
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Van Duinen MA, Niccolai V, Griez EJL. Challenging anxiety: a focus on the specificity of respiratory symptoms. Curr Top Behav Neurosci 2010; 2:229-250. [PMID: 21309112 DOI: 10.1007/7854_2009_33] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Physiological symptoms are characteristic features of anxiety states. Presumably, specific psychophysiological profiles differentiate between anxiety disorders, which would offer potential for diagnostic purposes. Abundant evidence points to a causal relationship between panic disorder and instability of respiratory regulation. However, the specificity of most measures that indicate aberrant functioning of the respiratory system in PD can be questioned. Possibly, the traditional measures of respiratory functioning are too restricted. The underlying respiratory vulnerability in PD seems to constitute a subtle, unstable trait, which calls for more sensitive and sophisticated measures of respiratory variability and chaos. To increase the probability of finding parameters with diagnostic specificity, the application of disorder specific challenge paradigms is recommended.
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Affiliation(s)
- M A Van Duinen
- Psychiatry & Neuropsychology, Maastricht University, The Netherlands
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72
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Psychophysiological correlates of chronic worry: Cued versus non-cued fear reaction. Int J Psychophysiol 2009; 74:280-7. [DOI: 10.1016/j.ijpsycho.2009.10.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2009] [Revised: 09/28/2009] [Accepted: 10/04/2009] [Indexed: 11/19/2022]
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73
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Abstract
OBJECTIVE To assess the external validity of laboratory baselines in panic disorder (PD), frequently associated with respiratory pattern abnormalities like increased respiratory variability and sighing, implying a stable pathophysiologic trait characteristic. METHODS Physical activity and a variety of breath-by-breath volumetric, timing, and variability measures of respiration were recorded in the daily life of 26 patients with PD and 26 healthy controls (HC), using a novel ambulatory monitoring system optimized for reliable assessment of respiratory pattern. Data were stratified for physical activity to eliminate its confounding effects. RESULTS Groups showed strong and consistent diurnal patterns in almost all respiratory variables. However, patients with PD did not differ from HC regarding any of the respiratory timing, volumetric and variability measures, with negligible group effect sizes for all measures. Patients with fewer self-reported respiratory symptoms of anxiety exhibited more pronounced rapid shallow breathing as well as diminished total breath time and its variability. CONCLUSIONS Despite state-of-the-art ambulatory assessment and sufficient statistical power to detect respiratory alterations previously observed in the laboratory, we found no evidence for such alterations in PD patients' daily life. Neither the total PD group nor patients with particularly pronounced respiratory symptomatology displayed increased respiratory variability. These results caution against interpreting results from laboratory baselines in PD as reflecting a stable trait characteristic. Rather, they likely represent a state-trait interaction due to enhanced reactivity of PD patients to novel environments. These results challenge aspects of respiratory theories of PD that were based on laboratory findings.
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74
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Vlemincx E, Van Diest I, Lehrer PM, Aubert AE, Van den Bergh O. Respiratory variability preceding and following sighs: a resetter hypothesis. Biol Psychol 2009; 84:82-7. [PMID: 19744538 DOI: 10.1016/j.biopsycho.2009.09.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 08/13/2009] [Accepted: 09/02/2009] [Indexed: 11/26/2022]
Abstract
Respiratory behavior is characterized by complex variability with structured and random components. Assuming that both a lack of variability and too much randomness represent suboptimal breathing regulation, we hypothesized that sighing acts as a resetter inducing structured variability. Spontaneous breathing was measured in healthy persons (N=42) during a 20min period of quiet sitting using the LifeShirt(®) System. Four blocks of 10 breaths with a 50% window overlap were determined before and after spontaneous sighs. Total respiratory variability of minute ventilation was measured using the coefficient of variation and structured (correlated) variability was quantified using autocorrelation. Towards a sigh, total variability gradually increased without concomittant changes in correlated variability, suggesting that randomness increased. After a sigh, correlated variability increased. No changes in variability were found in comparable epochs without intermediate sighs. We conclude that a sigh resets structured respiratory variability, enhancing information processing in the respiratory system.
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Affiliation(s)
- Elke Vlemincx
- Research Group on Health Psychology, Department of Psychology, University of Leuven, Tiensestraat 102, Leuven, Belgium
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75
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Niccolai V, van Duinen MA, Griez EJ. Respiratory patterns in panic disorder reviewed: a focus on biological challenge tests. Acta Psychiatr Scand 2009; 120:167-77. [PMID: 19548964 DOI: 10.1111/j.1600-0447.2009.01408.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To provide a systematic review of studies investigating respiration in PD and comments on relative inconsistencies. METHOD A Medline search of controlled studies focusing on pCO(2), respiratory rate, tidal volume, and minute volume in PD patients was conducted for baseline/resting condition, challenge, and recovery phase. Respiratory variability and comparisons between panickers and non-panickers were also examined. RESULTS Lower pCO(2) levels in PD subjects are a consistent finding during the baseline/resting condition, the challenge, and recovery phases. Tidal volume and minute volume are increased in PD subjects relative to controls during the baseline/resting condition. However, the most robust finding is a higher than normal respiratory variability, which appears to be a promising factor for the identification of respiratory etiopathological pathways in PD. CONCLUSION Respiratory variability might be a candidate for a biological marker of PD: an abnormal breathing pattern as found in panic disorder (PD) patients compared with controls might indicate instability of the respiratory homeostasis.
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Affiliation(s)
- V Niccolai
- School of Mental Health and Neurosciences, Maastricht University, 6200 AB, Maastricht, the Netherlands
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76
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Vlemincx E, van Diest I, de Peuter S, Bresseleers J, Bogaerts K, Fannes S, Li W, van den Bergh O. Why do you sigh? Sigh rate during induced stress and relief. Psychophysiology 2009; 46:1005-13. [DOI: 10.1111/j.1469-8986.2009.00842.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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77
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Nardi AE, Freire RC, Zin WA. Panic disorder and control of breathing. Respir Physiol Neurobiol 2009; 167:133-43. [DOI: 10.1016/j.resp.2008.07.011] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 07/15/2008] [Accepted: 07/17/2008] [Indexed: 10/21/2022]
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78
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Abstract
Converging evidence suggests that patients with panic disorder have a metabolic disturbance that may influence the regulation of arousal systems and confer vulnerability to 'spontaneous' panic attacks. The consistent finding of elevated brain lactate responses to various metabolic challenges in panic disorder appears to support this model, although the mechanism of this effect is not understood. Several mechanisms have been proposed to account for elevated brain lactate responses in panic disorder, including (1) brain hypoxia due to excessive cerebral vasoconstriction, and (2) a metabolic disturbance affecting lactate metabolism. Recent studies have shown that neural activation (for example, sensory stimulation) causes local lactate accumulation in the presence of increased oxygen availability. The current study used proton magnetic resonance spectroscopic measures of visual cortex lactate changes during visual stimulation in 15 untreated patients with panic disorder and 15 matched volunteers to critically test these two proposed mechanisms of elevated brain lactate responses in panic disorder. Visual cortex lactate/N-acetylaspartate increased during visual stimulation in both groups. The increase was significantly greater in the panic patients than in the comparison group. There were no group differences in end-tidal pCO(2). The finding that visual stimulation leads to significantly greater visual cortex lactate responses in panic patients is not predicted by the hypoxia model. These results suggest that a metabolic disturbance affecting the production or clearance of lactate is the cause of the elevated brain lactate responses consistently observed in panic disorder and provide further support for metabolic models of vulnerability to this illness.
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79
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Mujica-Parodi LR, Korgaonkar M, Ravindranath B, Greenberg T, Tomasi D, Wagshul M, Ardekani B, Guilfoyle D, Khan S, Zhong Y, Chon K, Malaspina D. Limbic dysregulation is associated with lowered heart rate variability and increased trait anxiety in healthy adults. Hum Brain Mapp 2009; 30:47-58. [PMID: 18041716 DOI: 10.1002/hbm.20483] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES We tested whether dynamic interaction between limbic regions supports a control systems model of excitatory and inhibitory components of a negative feedback loop, and whether dysregulation of those dynamics might correlate with trait differences in anxiety and their cardiac characteristics among healthy adults. EXPERIMENTAL DESIGN Sixty-five subjects received fMRI scans while passively viewing angry, fearful, happy, and neutral facial stimuli. Subjects also completed a trait anxiety inventory, and were monitored using ambulatory wake ECG. The ECG data were analyzed for heart rate variability, a measure of autonomic regulation. The fMRI data were analyzed with respect to six limbic regions (bilateral amygdala, bilateral hippocampus, Brodmann Areas 9, 45) using limbic time-series cross-correlations, maximum BOLD amplitude, and BOLD amplitude at each point in the time-series. PRINCIPAL OBSERVATIONS Diminished coupling between limbic time-series in response to the neutral, fearful, and happy faces was associated with greater trait anxiety, greater sympathetic activation, and lowered heart rate variability. Individuals with greater levels of trait anxiety showed delayed activation of Brodmann Area 45 in response to the fearful and happy faces, and lowered Brodmann Area 45 activation with prolonged left amygdala activation in response to the neutral faces. CONCLUSIONS The dynamics support limbic regulation as a control system, in which dysregulation, as assessed by diminished coupling between limbic time-series, is associated with increased trait anxiety and excitatory autonomic outputs. Trait-anxious individuals showed delayed inhibitory activation in response to overt-affect stimuli and diminished inhibitory activation with delayed extinction of excitatory activation in response to ambiguous-affect stimuli.
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Affiliation(s)
- Lilianne R Mujica-Parodi
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York 11794-8181, USA.
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80
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Bell HJ, Ferguson C, Kehoe V, Haouzi P. Hypocapnia increases the prevalence of hypoxia-induced augmented breaths. Am J Physiol Regul Integr Comp Physiol 2008; 296:R334-44. [PMID: 19091914 DOI: 10.1152/ajpregu.90680.2008] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Augmented breaths promote respiratory instability and have been implicated in triggering periods of sleep-disordered breathing. Since respiratory instability is well known to be exacerbated by hypocapnia, we asked whether one of the destabilizing effects of hypocapnia might be related to an increased prevalence of augmented breaths. With this question in mind, we first sought to determine whether hypoxia-induced augmented breaths are more prevalent when hypocapnia is also present. To do this, we studied the breath-by-breath ventilatory responses of a group of freely behaving adult rats in a variety of different respiratory background conditions. We found that the prevalence of augmented breaths was dramatically increased during hypocapnic-hypoxia compared with room air conditions. When hypocapnia was prevented during exposure to hypoxia by adding 5% CO2 to the inspired air, the rate of occurrence of augmented breaths was no greater than that observed in room air. The addition of CO2 alone to room air had no effect on the prevalence of augmented breaths. We conclude that in spontaneously breathing rats, hypoxia promotes the generation of augmented breaths, but only in poikilocapnic conditions, where hypocapnia develops. Our results, therefore, reveal a means by which CO2 exerts a stabilizing influence on breathing, which may be of particular relevance during sleep in conditions commonly associated with respiratory instability.
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Affiliation(s)
- Harold J Bell
- Penn State University College of Medicine, Heart and Vascular Institute, Milton S. Hershey Medical Center, 500 Univ. Dr., P.O. Box 850, Mail Code H047, Hershey, PA 17033-0850, USA.
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81
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Wollburg E, Meuret AE, Conrad A, Roth WT, Kim S. Psychophysiological reactions to two levels of voluntary hyperventilation in panic disorder. J Anxiety Disord 2008; 22:886-98. [PMID: 17950571 DOI: 10.1016/j.janxdis.2007.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 09/11/2007] [Accepted: 09/11/2007] [Indexed: 11/19/2022]
Abstract
Panic disorder (PD) patients usually react with more self-reported distress to voluntary hyperventilation (HV) than do comparison groups. Less consistently PD patients manifest physiological differences such as more irregular breathing and slower normalization of lowered end-tidal pCO(2) after HV. To test whether physiological differences before, during, or after HV would be more evident after more intense HV, we designed a study in which 16 PD patients and 16 non-anxious controls hyperventilated for 3 min to 25 mmHg, and another 19 PD patients and another 17 controls to 20 mmHg. Patients reacted to HV to 20 mmHg but not to 25 mmHg with more self-reported symptoms than controls. However, at neither HV intensity were previous findings of irregular breathing and slow normalization of pCO(2) replicated. In general, differences between patients and controls in response to HV were in the cognitive-language rather than in the physiological realm.
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Affiliation(s)
- Eileen Wollburg
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
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82
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Meuret AE, Wilhelm FH, Ritz T, Roth WT. Feedback of end-tidal pCO2 as a therapeutic approach for panic disorder. J Psychiatr Res 2008; 42:560-8. [PMID: 17681544 PMCID: PMC2890048 DOI: 10.1016/j.jpsychires.2007.06.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Accepted: 06/18/2007] [Indexed: 01/22/2023]
Abstract
BACKGROUND Given growing evidence that respiratory dysregulation is a central feature of panic disorder (PD) interventions for panic that specifically target respiratory functions could prove clinically useful and scientifically informative. We tested the effectiveness of a new, brief, capnometry-assisted breathing therapy (BRT) on clinical and respiratory measures in PD. METHODS Thirty-seven participants with PD with or without agoraphobia were randomly assigned to BRT or to a delayed-treatment control group. Clinical status, respiration rate, and end-tidal pCO(2) were assessed at baseline, post-treatment, 2-month and 12-month follow-up. Respiratory measures were also assessed during homework exercises using a portable capnometer as a feedback device. RESULTS Significant improvements (in PD severity, agoraphobic avoidance, anxiety sensitivity, disability, and respiratory measures) were seen in treated, but not untreated patients, with moderate to large effect sizes. Improvements were maintained at follow-up. Treatment compliance was high for session attendance and homework exercises; dropouts were few. CONCLUSIONS The data provide preliminary evidence that raising end-tidal pCO(2) by means of capnometry feedback is therapeutically beneficial for panic patients. Replication and extension will be needed to verify this new treatment's efficacy and determine its mechanisms.
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Affiliation(s)
- Alicia E Meuret
- Department of Psychology, Southern Methodist University, 6424 Hilltop Lane, Dallas, TX 75205, United States.
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83
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Crider A. Personality and electrodermal response lability: an interpretation. Appl Psychophysiol Biofeedback 2008; 33:141-8. [PMID: 18509756 DOI: 10.1007/s10484-008-9057-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Accepted: 05/16/2008] [Indexed: 11/24/2022]
Abstract
Electrodermal response (EDR) lability is a psychophysiological trait reflecting stable individual differences in electrodermal activation as indexed by frequency measures of phasic EDR activity. There is no consistent evidence that EDR lability reflects dispositional or clinical anxiety. However, EDR lability appears to be related to individual differences in the overt expression of emotional and antagonistic impulses. Greater EDR lability is associated with a relatively undemonstrative and agreeable disposition, whereas greater EDR stability is associated with a relatively expressive and antagonistic disposition. The inverse relationship between EDR lability and the expression of emotional and antagonistic impulses suggests that EDR lability may reflect individual differences in the effortful control of such expression. This hypothesis is consistent with cognitive effort interpretations of phasic EDR activity, with evidence of the sensitivity of phasic EDR activity to capacity-demanding tasks, and with evidence of reduced spare capacity among EDR labile individuals under cognitive challenge. Individual differences in effortful self-control may explain the association of greater EDR lability with essential hypertension and greater EDR stability with forms of antisocial behavior.
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Affiliation(s)
- Andrew Crider
- Department of Psychology, Williams College, Williamstown, MA 01267, USA.
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84
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Gomez P, Shafy S, Danuser B. Respiration, metabolic balance, and attention in affective picture processing. Biol Psychol 2008; 78:138-49. [DOI: 10.1016/j.biopsycho.2008.01.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Revised: 01/28/2008] [Accepted: 01/31/2008] [Indexed: 10/22/2022]
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85
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Conrad A, Isaac L, Roth WT. The psychophysiology of generalized anxiety disorder: 1. Pretreatment characteristics. Psychophysiology 2008; 45:366-76. [DOI: 10.1111/j.1469-8986.2007.00601.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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86
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Teigen KH. Is a sigh "just a sigh"? Sighs as emotional signals and responses to a difficult task. Scand J Psychol 2008; 49:49-57. [PMID: 18190402 DOI: 10.1111/j.1467-9450.2007.00599.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sighing and the interpretation of sighs in everyday life seem never to have been the subject of psychological research. A questionnaire study of sighing showed that people associate sighing mainly with negative, low-intensity and deactivated emotional states. A second study investigated self/other differences in the interpretation of sighs in four hypothetical situations, revealing that sighs in other people are primarily perceived as signs of sadness, whereas own sighs are more often believed to express a state of "giving up" something or somebody. In a third experimental study participants worked on difficult (insoluble) puzzles, which generated many futile solution attempts, often accompanied by sighs. It is concluded that sighs are often unintentional expressions of an activity, plan or desire that has to be discarded, creating a pause before it can be replaced by a novel initiative.
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87
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Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) and panic disorder (PD) are two anxiety disorders with prominent psychophysiological symptoms. The PTSD criterion of persistent hyperarousal suggests autonomic dysregulation, and the disorder has been associated with elevated heart rate. In contrast, PD has been associated with respiratory abnormalities such as low end-tidal Pco(2). An integrated analysis of automatic and respiratory function in a direct comparison of these anxiety disorders is currently lacking. METHODS Electrodermal, cardiovascular, and respiratory psychophysiology was examined in 23 PTSD patients, 26 PD patients, and 32 healthy individuals at baseline and during threat of shock. RESULTS At baseline, the PTSD patients, in contrast to the other two groups, were characterized by attenuated parasympathetic and elevated sympathetic control, as evidenced by low respiratory sinus arrhythmia (a measure of cardiac vagal control) and high electrodermal activity. They also displayed elevated heart rate and cardiovascular sympathetic activation in comparison with healthy controls. PD patients exhibited lower Pco(2) (hypocapnia) and higher cardiovascular sympathetic activation compared with healthy controls. PTSD patients, but not PD patients, sighed more frequently than controls. During the threat of shock phase, the PTSD group demonstrated blunted electrodermal responses. CONCLUSIONS Persistent hyperarousal symptoms in PTSD seem to be due to high sympathetic activity coupled with low parasympathetic cardiac control. Respiratory abnormalities were also present in PTSD. Several psychophysiological measures exhibited group-comparison effect sizes in the order of 1.0, supporting their potential for enhancing differential diagnosis and possibly suggesting utility as endophenotypes in genetic studies of anxiety disorders.
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88
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Kreibig SD, Wilhelm FH, Roth WT, Gross JJ. Cardiovascular, electrodermal, and respiratory response patterns to fear- and sadness-inducing films. Psychophysiology 2007; 44:787-806. [PMID: 17598878 DOI: 10.1111/j.1469-8986.2007.00550.x] [Citation(s) in RCA: 232] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Responses to fear- and sadness-inducing films were assessed using a broad range of cardiovascular (heart rate, T-wave amplitude, low- and high-frequency heart rate variability, stroke volume, preejection period, left-ventricular ejection time, Heather index, blood pressure, pulse amplitude and transit time, and finger temperature), electrodermal (level, response rate, and response amplitude), and respiratory (rate, tidal volume and its variability, inspiratory flow rate, duty cycle, and end-tidal pCO(2)) measures. Subjective emotional experience and facial behavior (Corrugator Supercilii and Zygomaticus Major EMG) served as control measures. Results indicated robust differential physiological response patterns for fear, sadness, and neutral (mean classification accuracy 85%). Findings are discussed in terms of the fight-flight and conservation-withdrawal responses and possible limitations of a valence-arousal categorization of emotion in affective space.
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Affiliation(s)
- Sylvia D Kreibig
- Department of Psychology, Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland.
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89
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Conrad A, Roth WT. Muscle relaxation therapy for anxiety disorders: it works but how? J Anxiety Disord 2007; 21:243-64. [PMID: 16949248 DOI: 10.1016/j.janxdis.2006.08.001] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Revised: 07/05/2006] [Accepted: 08/01/2006] [Indexed: 10/24/2022]
Abstract
Muscle relaxation therapy (MRT) has continued to play an important role in the modern treatment of anxiety disorders. Abbreviations of the original progressive MRT protocol [Jacobson, E. (1938). Progressive relaxation (2nd ed.). Chicago: University of Chicago Press] have been found to be effective in panic disorder (PD) and generalized anxiety disorder (GAD). This review describes the most common MRT techniques, summarizes recent evidence of their effectiveness in treating anxiety, and explains their rationale and physiological basis. We conclude that although GAD and PD patients may exhibit elevated muscle tension and abnormal autonomic and respiratory measures during laboratory baseline assessments, the available evidence does not allow us to conclude that physiological activation decreases over the course of MRT in GAD and PD patients, even when patients report becoming less anxious. Better-designed studies will be required to identify the mechanisms of MRT and to advance clinical practice.
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Affiliation(s)
- Ansgar Conrad
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
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90
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Sikter A, Frecska E, Braun IM, Gonda X, Rihmer Z. The role of hyperventilation: hypocapnia in the pathomechanism of panic disorder. REVISTA BRASILEIRA DE PSIQUIATRIA 2007; 29:375-9. [PMID: 17713689 DOI: 10.1590/s1516-44462006005000048] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Accepted: 04/02/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: The authors present a profile of panic disorder based on and generalized from the effects of acute and chronic hyperventilation that are characteristic of the respiratory panic disorder subtype. The review presented attempts to integrate three premises: hyperventilation is a physiological response to hypercapnia; hyperventilation can induce panic attacks; chronic hyperventilation is a protective mechanism against panic attacks. METHOD: A selective review of the literature was made using the Medline database. Reports of the interrelationships among panic disorder, hyperventilation, acidosis, and alkalosis, as well as catecholamine release and sensitivity, were selected. The findings were structured into an integrated model. DISCUSSION: The panic attacks experienced by individuals with panic disorder develop on the basis of metabolic acidosis, which is a compensatory response to chronic hyperventilation. The attacks are triggered by a sudden increase in (pCO2) when the latent (metabolic) acidosis manifests as hypercapnic acidosis. The acidotic condition induces catecholamine release. Sympathicotonia cannot arise during the hypercapnic phase, since low pH decreases catecholamine sensitivity. Catecholamines can provoke panic when hyperventilation causes the hypercapnia to switch to hypocapnic alkalosis (overcompensation) and catecholamine sensitivity begins to increase. CONCLUSION: Therapeutic approaches should address long-term regulation of the respiratory pattern and elimination of metabolic acidosis.
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Affiliation(s)
- Andras Sikter
- Department of Internal Medicine, St. Rokus Hospital, Budapest, Hungary
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91
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Conrad A, Müller A, Doberenz S, Kim S, Meuret AE, Wollburg E, Roth WT. Psychophysiological effects of breathing instructions for stress management. Appl Psychophysiol Biofeedback 2007; 32:89-98. [PMID: 17520360 DOI: 10.1007/s10484-007-9034-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Accepted: 04/04/2007] [Indexed: 10/23/2022]
Abstract
Stressed and tense individuals often are recommended to change the way they breathe. However, psychophysiological effects of breathing instructions on respiration are rarely measured. We tested the immediate effects of short and simple breathing instructions in 13 people seeking treatment for panic disorder, 15 people complaining of daily tension, and 15 controls. Participants underwent a 3-hour laboratory session during which instructions to direct attention to breathing and anti-hyperventilation instructions to breathe more slowly, shallowly, or both were given. Respiratory, cardiac, and electrodermal measures were recorded. The anti-hyperventilation instructions failed to raise end-tidal pCO(2) above initial baseline levels for any of the groups because changes in respiratory rate were compensated for by changes in tidal volume and vice versa. Paying attention to breathing significantly reduced respiratory rate and decreased tidal volume instability compared to the other instructions. Shallow breathing made all groups more anxious than did other instructions. Heart rate and skin conductance were not differentially affected by instructions. We conclude that simple and short instructions to alter breathing do not change respiratory or autonomic measures in the direction of relaxation, except for attention to breathing, which increases respiratory stability. To understand the results of breathing instructions for stress and anxiety management, respiration needs to be monitored physiologically.
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Affiliation(s)
- Ansgar Conrad
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, and the Veterans Affairs Health Care System, Palo Alto, CA 94304, USA
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92
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Giardino ND, Friedman SD, Dager SR. Anxiety, respiration, and cerebral blood flow: implications for functional brain imaging. Compr Psychiatry 2007; 48:103-12. [PMID: 17292699 PMCID: PMC1820771 DOI: 10.1016/j.comppsych.2006.11.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Accepted: 11/01/2006] [Indexed: 11/25/2022] Open
Abstract
Brain functional imaging methods, such as fMRI, are sensitive to changes in cerebral blood flow (CBF) that are normally associated with changes in regional neural activation. However, other endogenous and exogenous factors can alter CBF independently of brain neural activity, thus complicating the interpretation of functional imaging data. The presence of an anxiety disorder, as well as change in state anxiety, is often accompanied by respiratory alterations that affect arterial CO(2) tensions and produce significant changes in CBF that are independent of task-related neural activation. Therefore, the effects of trait and state anxiety need to be given close consideration in interpreting functional imaging findings. In this paper, we review the dependence of most brain functional imaging methods on localized changes in CBF and the potentially confounding effects of anxiety-related alterations of respiration on interpreting patterns of functional activation. Approaches for addressing these effects are discussed.
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Affiliation(s)
- Nicholas D Giardino
- Department of Radiology, University of Washington School of Medicine, Seattle, WA 98105, USA
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93
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Van Diest I, Thayer JF, Vandeputte B, Van de Woestijne KP, Van den Bergh O. Anxiety and respiratory variability. Physiol Behav 2006; 89:189-95. [PMID: 16859718 DOI: 10.1016/j.physbeh.2006.05.041] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2005] [Revised: 01/03/2006] [Accepted: 05/30/2006] [Indexed: 10/24/2022]
Abstract
Associations of inter- and intra-individual differences in anxiety and fear with within subject variability in breathing parameters were explored. Timing and volume components of respiration and FETCO(2) were measured non-intrusively before and during anxious and fearful imagery in 98 young women. Trait anxiety was associated with less variability in several breathing parameters during baseline preceding imagery. Significant decreases in the variability of expiratory time and inspiratory drive were also observed during anxious imagery. During fearful imagery, however, the variability of FETCO(2) increased compared to baseline. Results on anxiety are largely in agreement with models that posit that healthy systems are characterized by variability and flexibility. The paradoxical findings for fearful imagery enhance the importance of a distinction between fearful and anxious affects.
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Affiliation(s)
- Ilse Van Diest
- Department of Psychology, University of Leuven, B-3000 Leuven, Belgium.
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94
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Van Diest I, De Peuter S, Piedfort K, Bresseleers J, Devriese S, Van de Woestijne KP, Van den Bergh O. Acquired lightheadedness in response to odors after hyperventilation. Psychosom Med 2006; 68:340-7. [PMID: 16554402 DOI: 10.1097/01.psy.0000204782.49159.79] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to investigate whether lightheadedness in response to odors could be acquired through previous associations with hyperventilation-induced hypocapnia. METHODS Diluted ammonia and acetic acid served as conditional odor cues (CSs) in a differential associative learning paradigm. Hyperventilation-induced hypocapnia (unconditional stimulus [US]) was used to induce lightheadedness. In a training phase, participants (n = 28) performed three hypocapnic and three normocapnic overbreathing trials of 60 seconds each. One odor was consistently paired with the hypocapnic overbreathing (CS+); the other (control) odor was paired with normocapnic overbreathing (CS-). In the test phase, each odor was presented once during spontaneous breathing and once during normocapnic overventilation. Lightheadedness was assessed online during each breathing trial, which was followed by an extensive hyperventilation symptom checklist. Fractional end-tidal CO2, breathing frequency, and inspiratory volume were measured throughout the experiment. RESULTS In the test phase, participants experienced lightheadedness more quickly in response to the odor that had been paired with hypocapnic overbreathing compared with the control odor. They also scored higher on the symptom "feeling unreal." CONCLUSION Lightheadedness in response to odors can be acquired easily. The present results may help to elucidate the paradox that both avoidance and exposure to chemicals seem to be effective in reducing symptoms in idiopathic environmental illness.
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Affiliation(s)
- Ilse Van Diest
- Department of Psychology, University of Leuven, Leuven, Belgium.
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95
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Myers LJ, Derchak PA. Effective method for quantifying respiratory effective method for quantifying respiratory subsequent marker of anxiety. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2006; Suppl:6601-6604. [PMID: 17959463 DOI: 10.1109/iembs.2006.260898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Ambulatory respiratory data was gathered using inductive lethysmography technology with synchronous ECG(LifeShirte , VivoMetrics, Ventura, CA) during a study to evaluate the effect of an anxiolytic on heart rate variability and respiratory pattern as indicators of anxiety state. Positive control (PCR; post-marketing, broadly prescribed anxiolytic)and placebo (PBO) data was included in the analysis. Tidal volume waveforms were the result of a weighted sum of the abdominal and rib cage IP bands according to the qualitative diagnostic calibration method. A breath detection algorithm was run to identify the beginning and end of inhalation in these waveforms. Several types of respiratory artifact are common with ambulatory, non-controlled recordings and a consistent and reliable means is necessary to identify and manage such artifacts. An automated approach was adopted to define a reliable breathing index for each breath that labels that breath as contaminated by artifact or not. The root mean square of successive differences (RMSSD) were computed on the tidal inspiratory volumes and total breath times for each epoch, both for all breaths and for only those breaths that were labeled as reliable. The results indicate that when a priori automated artifact detection is included, there is a significant linear decrease in both the volume and time indices for the PCR, whilst no significant differences were noted in the PBO group. Analyzing the data without prior marking of reliable breaths showed no significant results for either group. This study demonstrates the validity of ambulatory respiratory measurements as a means to assess anxiety and establishes the need to first identify reliable breathing periods prior to the analysis of ambulatory respiratory data.
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Affiliation(s)
- Lance J Myers
- VivoMetrics Inc 121 N Fir St, Suite E Ventura, California 93001, USA.
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96
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Wilhelm FH, Pfaltz MC, Gross JJ, Mauss IB, Kim SI, Wiederhold BK. Mechanisms of virtual reality exposure therapy: the role of the behavioral activation and behavioral inhibition systems. Appl Psychophysiol Biofeedback 2005; 30:271-84. [PMID: 16167191 DOI: 10.1007/s10484-005-6383-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
J. A. Gray's (1975) theory distinguishes between two motivational systems, which he refers to as the behavioral activation system (BAS) and the behavioral inhibition system (BIS). D. C. Fowles (1980) has shown that heart rate responses reflect activity of the BAS, and electrodermal responses reflect activity of the BIS. Both BAS and BIS are reliably activated during in-vivo exposure to fearful situations (F. H. Wilhelm & W. T. Roth, 1998). However, due to the constraints imposed by virtual reality (VR), we hypothesized that VR exposure to fearful situations would activate the BIS alone. To test this hypothesis, a VR free-standing elevator simulation was presented to participants selected for high and low fear of heights. As predicted, the high-anxious group strongly responded electrodermally (effect size d = 1.53), but showed only minimal HR elevations during exposure (d = 0.12), and little other cardiovascular or respiratory changes. The low-anxious control group showed little electrodermal and HR reactivity (d = 0.28 and 0.12). A comparison with data from a previous study demonstrated that this pattern was in stark contrast to the large electrodermal and cardiovascular response observed during situational in-vivo exposure outside the laboratory. We conclude that the BIS, but not BAS, is selectively activated during VR exposure, causing discordance between self-report and commonly used physiological measures of anxiety. Results are discussed within the framework of E. B. Foa & M. J. Kozak's (1986) emotional processing theory of fear modification, suggesting different mechanisms underlying VR and in-vivo exposure treatments.
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Affiliation(s)
- Frank H Wilhelm
- Institute for Psychology, University of Basel, Basel, Switzerland.
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97
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Roth WT. Physiological markers for anxiety: Panic disorder and phobias. Int J Psychophysiol 2005; 58:190-8. [PMID: 16137780 DOI: 10.1016/j.ijpsycho.2005.01.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2004] [Accepted: 01/22/2005] [Indexed: 11/29/2022]
Abstract
Physiological activation is a cardinal symptom of anxiety, although physiological measurement is still not used for psychiatric diagnosis. An ambulatory study of phobics who were afraid of highway driving showed a concordance between self-reported anxiety during driving, autonomic activation, hypocapnia, and sighing respiration. Patients with panic attacks do not exhibit autonomic activation when they are quietly sitting and not having panic attacks, but do have the same respiratory abnormalities as driving phobics, suggesting that these abnormalities could be a marker for panic disorder. Such abnormalities are compatible with both the false suffocation alarm (D. Klein) and hyperventilation (R. Ley) theories of panic. Hypocapnia, however, is often absent during full-blown panic attacks. Since activation functions as preparation for physical activity, it may not occur when a patient has learned that avoidance of fear by flight or fight is futile. We developed a capnometry feedback assisted breathing training therapy for panic disorder designed to reduce hyperventilation and making breathing regular. Without feedback, conventional therapeutic breathing instructions may actually increase hyperventilation by increasing dyspnea. Five weekly therapy sessions accompanied by daily home practice with a capnometer produced marked clinical improvement compared to changes in an untreated group. Improvement was sustained over a 12-month follow-up period. The therapist avoided any statements or procedures designed to alter cognitions. Improvement occurred regardless of whether patients initially reported mostly respiratory or non-respiratory symptoms during their attacks. There is evidence that modifying any of the three systems comprising a fear network can be therapeutic, as exemplified by cognitive therapy modifying thoughts, exposure therapy modifying avoidance, and breathing training procedures modifying pCO(2).
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Affiliation(s)
- Walton T Roth
- Department of Veterans Affairs Health Care System, Palo Alto, CA 94304, USA.
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98
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Poma SZ, Milleri S, Squassante L, Nucci G, Bani M, Perini GI, Merlo-Pich E. Characterization of a 7% carbon dioxide (CO2) inhalation paradigm to evoke anxiety symptoms in healthy subjects. J Psychopharmacol 2005; 19:494-503. [PMID: 16166187 DOI: 10.1177/0269881105056533] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present study is aimed at characterizing the carbon dioxide (CO2) procedure in healthy subjects to achieve reliable provocation of anxiety symptoms. Thirty healthy subjects inhaled in single-blind both compressed air and 7% CO2 mixture. Panic Symptom List (PSLIII-R), Visual Analogue Scale-Anxiety (VAS-A), State Anxiety Inventory (STAI-Y/1), respiratory parameters and skin conductance were measured. 'Responders' were classified depending on PSLIII-R scores after CO2. Twelve out of the 21 'responders' performed a second test to assess test-retest repeatability. In 21 subjects Delta%VAS-A (45.4 +/- 32.1) and PSLIII-R (pre-test 2.3 +/-2.1, post-test 17.5 +/- 8.2) but not STAI-Y/1, significantly increased during CO2 inhalation. Respiratory Rate, Minute Volume, end-Tidal CO2 and skin conductance rose in 'responders'. Repeatability was studied with Bland-Altman plots, revealing mean difference between tests close to 0 for both Delta%VAS-A and PSLIII-R. Among physiologic parameters, end-Tidal CO2 and Respiratory Rate showed good repeatability, with a within-subject CV of 9.2% and 6%, respectively. The challenge produced measurable response in healthy subjects. Good test-retest repeatability was observed in 'responders'. These data indicate that the test can be suitable for testing putative anti-panic or anxiolytic drugs in clinical studies using a within subject, crossover design.
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Affiliation(s)
- Stefano Zanone Poma
- Psychiatry Centre of Excellence for Drug Discovery, Medical Research Centre, GlaxoSmithKline, Verona, Italy.
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Meuret AE, Ritz T, Wilhelm FH, Roth WT. Voluntary hyperventilation in the treatment of panic disorder—functions of hyperventilation, their implications for breathing training, and recommendations for standardization. Clin Psychol Rev 2005; 25:285-306. [PMID: 15792851 DOI: 10.1016/j.cpr.2005.01.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2004] [Revised: 11/18/2004] [Accepted: 01/11/2005] [Indexed: 11/21/2022]
Abstract
Hyperventilation has numerous theoretical and empirical links to anxiety and panic. Voluntary hyperventilation (VH) tests have been applied experimentally to understand psychological and physiological mechanisms that produce and maintain anxiety, and therapeutically in the treatment of anxiety disorders. From the theoretical perspective of hyperventilation theories of anxiety, VH is useful diagnostically to the clinician and educationally to the patient. From the theoretical perspective of cognitive-behavior therapy, VH is a way to expose patients with panic disorder to sensations associated with panic and to activate catastrophic cognitions that need restructuring. Here we review panic disorder treatment studies using breathing training that have included VH. We differentiate the roles of VH in diagnosis, education about symptoms, training of breathing strategies, interoceptive exposure, and outcome measurement--discussing methodological issues specific to these roles and VH test reliability and validity. We propose how VH procedures might be standardized in future studies.
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Affiliation(s)
- Alicia E Meuret
- Center for Anxiety and Related Disorders, Boston University, USA.
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100
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De Jong MMJ, An K, McKinley S, Garvin BJ, Hall LA, Moser DK. Using a 0-10 Scale for Assessment of Anxiety in Patients With Acute Myocardial Infarction. Dimens Crit Care Nurs 2005; 24:139-46. [PMID: 15912064 DOI: 10.1097/00003465-200505000-00008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Patients with acute myocardial infarction (AMI) often experience anxiety, an emotion that predicts adverse physiologic outcomes. The purpose of this study was to determine whether a single-item anxiety assessment instrument, the Anxiety Level Index (ALI), is a valid alternative to the State Anxiety Index (SAI) or the anxiety subscale of the Brief Symptom Inventory (BSI) for assessing state anxiety for patients with AMI. In this prospective multicenter study, 243 inpatients with AMI rated their anxiety using the SAI, the anxiety subscale of the BSI, and the ALI. Anxiety Level Index scores were compared to SAI and BSI anxiety subscale scores. There were moderate, positive correlations between the SAI and the ALI (rs = 0.52, P < .001), and between the ALI and the anxiety subscale of the BSI (rs = 0.45, P < .001). Although ALI scores were moderately and significantly correlated with scores on the SAI and the BSI anxiety subscales, the results of the Bland-Altman method indicate a lack of construct validity of the single-item measure. The quest continues to construct a simple self-report measure of anxiety that is appropriate for critically ill patients with AMI.
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