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Tunnell NC, Corner SE, Roque AD, Kroll JL, Ritz T, Meuret AE. Biobehavioral approach to distinguishing panic symptoms from medical illness. Front Psychiatry 2024; 15:1296569. [PMID: 38779550 PMCID: PMC11109415 DOI: 10.3389/fpsyt.2024.1296569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/19/2024] [Indexed: 05/25/2024] Open
Abstract
Panic disorder is a common psychiatric diagnosis characterized by acute, distressing somatic symptoms that mimic medically-relevant symptoms. As a result, individuals with panic disorder overutilize personal and healthcare resources in an attempt to diagnose and treat physical symptoms that are often medically benign. A biobehavioral perspective on these symptoms is needed that integrates psychological and medical knowledge to avoid costly treatments and prolonged suffering. This narrative review examines six common somatic symptoms of panic attacks (non-cardiac chest pain, palpitations, dyspnea, dizziness, abdominal distress, and paresthesia), identified in the literature as the most severe, prevalent, or critical for differential diagnosis in somatic illness, including long COVID. We review somatic illnesses that are commonly comorbid or produce panic-like symptoms, their relevant risk factors, characteristics that assist in distinguishing them from panic, and treatment approaches that are typical for these conditions. Additionally, this review discusses key factors, including cultural considerations, to assist healthcare professionals in differentiating benign from medically relevant symptoms in panic sufferers.
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Affiliation(s)
- Natalie C. Tunnell
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Department of Psychiatry & Behavioral Sciences, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Sarah E. Corner
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Andres D. Roque
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Primary Care Department, Miami VA Healthcare System, Miami, FL, United States
| | - Juliet L. Kroll
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Alicia E. Meuret
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
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Gavelin HM, Neely AS, Aronsson I, Josefsson M, Andersson L. Mental fatigue, cognitive performance and autonomic response following sustained mental activity in clinical burnout. Biol Psychol 2023; 183:108661. [PMID: 37598882 DOI: 10.1016/j.biopsycho.2023.108661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE To investigate the effects of sustained mental activity on perceptions of mental fatigue, cognitive performance, and autonomic response in patients with clinical burnout as compared to a healthy control group. METHODS Patients with clinical burnout (n = 30) and healthy control participants (n = 30) completed a 3-hour test session, in which they were administered a set of cognitive tests before and after an effortful cognitive task with concurrent sound exposure. Perceptions of mental fatigue and task demands (mental effort and concentration difficulties) were assessed repeatedly over the course of the test session. Heart rate variability was recorded to index autonomic response. RESULTS In comparison with controls, perceived mental fatigue increased earlier in the session for the clinical burnout group and did not recover following a short rest period. Throughout the session, patients rated the tasks as more demanding and showed less improvement on measures of attention and processing speed, inhibition and working memory. While autonomic responses were initially comparable, there was a unique decrease in high-frequency heart rate variability in the clinical burnout group after extended testing and exposure. CONCLUSION Patients with clinical burnout are affected differently than healthy controls by sustained mental activity, as reflected by ratings of perceived mental fatigue, aspects of cognitive performance and autonomic response. Further investigation into the role of autonomic regulation in relation to cognitive symptoms in clinical burnout is warranted.
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Affiliation(s)
| | - Anna Stigsdotter Neely
- Department of Social Sciences, Technology and Arts; Department of Health, Education and Technology, Luleå University of Technology, Sweden; Department of Social and Psychological studies, Karlstad University, Sweden
| | | | - Maria Josefsson
- Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Sweden
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Goheen J, Anderson JAE, Zhang J, Northoff G. From Lung to Brain: Respiration Modulates Neural and Mental Activity. Neurosci Bull 2023; 39:1577-1590. [PMID: 37285017 PMCID: PMC10533478 DOI: 10.1007/s12264-023-01070-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/10/2023] [Indexed: 06/08/2023] Open
Abstract
Respiration protocols have been developed to manipulate mental states, including their use for therapeutic purposes. In this systematic review, we discuss evidence that respiration may play a fundamental role in coordinating neural activity, behavior, and emotion. The main findings are: (1) respiration affects the neural activity of a wide variety of regions in the brain; (2) respiration modulates different frequency ranges in the brain's dynamics; (3) different respiration protocols (spontaneous, hyperventilation, slow or resonance respiration) yield different neural and mental effects; and (4) the effects of respiration on the brain are related to concurrent modulation of biochemical (oxygen delivery, pH) and physiological (cerebral blood flow, heart rate variability) variables. We conclude that respiration may be an integral rhythm of the brain's neural activity. This provides an intimate connection of respiration with neuro-mental features like emotion. A respiratory-neuro-mental connection holds the promise for a brain-based therapeutic usage of respiration in mental disorders.
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Affiliation(s)
- Josh Goheen
- The Royal Ottawa Mental Health Centre, The University of Ottawa, Ottawa, K1Z 7K4, Canada.
- Department of Cognitive Science, Carleton University, Ottawa, K1S 5B6, Canada.
| | - John A E Anderson
- Department of Cognitive Science, Carleton University, Ottawa, K1S 5B6, Canada
| | - Jianfeng Zhang
- Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen, 518060, China
- School of Psychology, Shenzhen University, Shenzhen, 518060, China
| | - Georg Northoff
- The Royal Ottawa Mental Health Centre, The University of Ottawa, Ottawa, K1Z 7K4, Canada
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Craske MG, Meuret AE, Echiverri-Cohen A, Rosenfield D, Ritz T. Positive affect treatment targets reward sensitivity: A randomized controlled trial. J Consult Clin Psychol 2023; 91:350-366. [PMID: 36892884 PMCID: PMC10213148 DOI: 10.1037/ccp0000805] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
OBJECTIVE Determine whether a novel psychosocial treatment for positive affect improves clinical status and reward sensitivity more than a form of cognitive behavioral therapy that targets negative affect and whether improvements in reward sensitivity correlate with improvements in clinical status. METHOD In this assessor-blinded, parallel-group, multisite, two-arm randomized controlled clinical superiority trial, 85 treatment-seeking adults with severely low positive affect, moderate-to-severe depression or anxiety, and functional impairment received 15 weekly individual therapy sessions of positive affect treatment (PAT) or negative affect treatment (NAT). Clinical status measures were self-reported positive affect, interviewer-rated anhedonia, and self-reported depression and anxiety. Target measures were eleven physiological, behavioral, cognitive, and self-report measures of reward anticipation-motivation, response to reward attainment, and reward learning. All analyses were intent-to-treat. RESULTS Compared to NAT, individuals receiving PAT achieved superior improvements in the multivariate clinical status measures at posttreatment, b = .37, 95% CI [.15, .59], t(109) = 3.34, p = .001, q = .004, d = .64. Compared to NAT, individuals receiving PAT also achieved higher multivariate reward anticipation-motivation, b = .21, 95% CI [.05, .37], t(268) = 2.61, p = .010, q = .020, d = .32, and higher multivariate response to reward attainment, b = .24, 95% CI [.02, .45], t(266) = 2.17, p = .031, q = .041, d = .25, at posttreatment. Measures of reward learning did not differ between the two groups. Improvements in reward anticipation-motivation and in response to reward attainment correlated with improvements in the clinical status measures. CONCLUSIONS Targeting positive affect results in superior improvements in clinical status and reward sensitivity than targeting negative affect. This is the first demonstration of differential target engagement across two psychological interventions for anxious or depressed individuals with low positive affect. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Michelle G. Craske
- Department of Psychology, UCLA
- Department of Psychiatry and Biobehavioral Sciences, UCLA
| | | | | | | | - Thomas Ritz
- Department of Psychology, Southern Methodist University
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Cuyler RN, Katdare R, Thomas S, Telch M. Real-world outcomes of an innovative digital therapeutic for treatment of panic disorder and PTSD: A 1,500 patient effectiveness study. Front Digit Health 2022; 4:976001. [DOI: 10.3389/fdgth.2022.976001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/21/2022] [Indexed: 11/18/2022] Open
Abstract
ObjectivePrior clinical trials have shown consistent clinical benefit for Capnometry Guided Respiratory Intervention (CGRI), a prescription digital therapeutic for the treatment of panic disorder (PD) and post-traumatic stress disorder (PTSD). The purpose of this study is to report real-world outcomes in a series of patients treated with the intervention in clinical practice.DesignThis paper reports pre- and post-treatment self-reported symptom reduction, measures of respiratory rate and end-tidal carbon dioxide levels, drop-out and adherence rates drawn from an automatic data repository in a large real-world series of patients receiving CGRI for panic disorder and PTSD.SettingPatients used the intervention in their homes, supported by telehealth coaching.ParticipantsPatients meeting symptom criteria for panic disorder (n = 1,395) or posttraumatic stress disorder (n = 174) were treated following assessment by a healthcare professional.InterventionCapnometry Guided Respiratory Intervention is a 28-day home-based treatment that provides breath-to-breath feedback of respiratory rate and exhaled carbon dioxide levels, aimed at normalizing respiratory style and increasing patients’ mastery for coping with symptoms of stress, anxiety, and panic. Health coaches provide initial training with weekly follow up during the treatment episode. Remote data upload and monitoring facilitates individualized coaching and aggregate outcomes analysis.Main outcome measuresSelf-reported Panic Disorder Severity Scale (PDSS) and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) scores were obtained at pre-treatment and post-treatment.ResultsPanic disorder (PD) patients showed a mean pre-to-post-treatment reduction in total PDSS scores of 50.2% (P < 0.001, d = 1.31). Treatment response rates for PD (defined as a 40% or greater reduction in PDSS total scores) were observed in 65.3% of the PD patients. PTSD patients showed a pre-to-post-treatment reduction in total PCL-5 scores of 41.1% (P < 0.001, d = 1.16). The treatment response rate for PTSD (defined as a ≥10-point reduction in PCL-5 scores) was 72.4%. In an additional analysis of response at the individual level, 55.7% of panic disorder patients and 53.5% of PTSD patients were classified as treatment responders using the Reliable Change Index. Patients with both normal and below-normal baseline exhaled CO2 levels experienced comparable benefit. Across the 28-day treatment period, mean adherence rates of 74.8% (PD) and 74.9% (PTSD) were recorded during the 28-day treatment. Dropout rates were 10% (PD) and 11% (PTSD) respectively.ConclusionsThe results from this cohort of 1,569 patients treated with the CGRI intervention demonstrate significant rates of symptom reduction and adherence consistent with prior published clinical trials. The brief duration of treatment, high adherence rates, and clinical benefit suggests that CGRI provides an important addition to treatment options for panic disorder and PTSD.
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Abstract
Breathing is a vital rhythmic motor behavior with a surprisingly broad influence on the brain and body. The apparent simplicity of breathing belies a complex neural control system, the breathing central pattern generator (bCPG), that exhibits diverse operational modes to regulate gas exchange and coordinate breathing with an array of behaviors. In this review, we focus on selected advances in our understanding of the bCPG. At the core of the bCPG is the preBötzinger complex (preBötC), which drives inspiratory rhythm via an unexpectedly sophisticated emergent mechanism. Synchronization dynamics underlying preBötC rhythmogenesis imbue the system with robustness and lability. These dynamics are modulated by inputs from throughout the brain and generate rhythmic, patterned activity that is widely distributed. The connectivity and an emerging literature support a link between breathing, emotion, and cognition that is becoming experimentally tractable. These advances bring great potential for elucidating function and dysfunction in breathing and other mammalian neural circuits.
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Affiliation(s)
- Sufyan Ashhad
- Department of Neurobiology, University of California at Los Angeles, Los Angeles, California, USA;
| | - Kaiwen Kam
- Department of Cell Biology and Anatomy, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | | | - Jack L Feldman
- Department of Neurobiology, University of California at Los Angeles, Los Angeles, California, USA;
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Harrison OK, Russell BR, Pattinson KTS. Perceptual and Ventilatory Responses to Hypercapnia in Athletes and Sedentary Individuals. Front Physiol 2022; 13:820307. [PMID: 35370804 PMCID: PMC8964958 DOI: 10.3389/fphys.2022.820307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/08/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose Hypercapnic chemosensitivity traditionally captures the ventilatory response to elevated pressures of carbon dioxide in the blood. However, hypercapnia also contributes to subjective breathing perceptions, and previously we demonstrated a closer matching of perception to changes in ventilation in athletes compared to controls. Here we investigated any potential underlying hypercapnic chemosensitivity differences between groups, and explored whether these measures relate to ventilatory and perceptual responses during exercise as well as trait levels of affect. Methods A hypercapnic challenge, incremental maximal exercise test and affective questionnaires were completed by 20 endurance athletes and 20 age-/sex-matched sedentary controls. The hypercapnic challenge involved elevating end-tidal PCO2 by 0.8% (6.1 mmHg) and 1.5% (11.2 mmHg) for 3 min each (randomised), with constant end-tidal oxygen. Ventilatory and perceptual responses to hypercapnia were compared between groups, and within each group the relationships between hypercapnic chemosensitivity (slope analyses) and exercising ventilation and perceptions were calculated using Spearman’s non-parametric correlations. Results While absolute ventilation differences during hypercapnia and exercise were observed, no group differences were found across hypercapnic chemosensitivity (slope) measures. Correlation analyses revealed the anxiety hypercapnic response was related to maximal exercise anxiety, but only in sedentary individuals. Conclusion Ventilatory and perceptual hypercapnic chemosensitivity do not differ between athletes and sedentary individuals. However, ventilatory and anxiety hypercapnic chemosensitivities were related to ventilatory and anxiety responses during exercise in untrained individuals only. Athletes may employ additional strategies during exercise to reduce the influence of chemosensitivity on ventilatory and perceptual responses.
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Affiliation(s)
- Olivia K. Harrison
- Department of Psychology, University of Otago, Dunedin, New Zealand
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Integrative NeuroImaging, University of Oxford, Oxford, United Kingdom
- *Correspondence: Olivia K. Harrison,
| | | | - Kyle T. S. Pattinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Integrative NeuroImaging, University of Oxford, Oxford, United Kingdom
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Lavretsky H, Feldman PhD JL. Precision Medicine for Breath-Focused Mind-Body Therapies for Stress and Anxiety: Are We Ready Yet? Glob Adv Health Med 2021; 10:2164956120986129. [PMID: 33489480 PMCID: PMC7809295 DOI: 10.1177/2164956120986129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/05/2020] [Accepted: 12/16/2020] [Indexed: 11/16/2022] Open
Abstract
In this viewpoint, we present an argument for transdisciplinary "precision medicine" approaches that combine studies of basic neurobiology of breathing in animal and human models of stress that can help characterize physiological and neural biomarkers and mechanisms of breathing control and emotion regulation in humans. Such mechanistic research is fundamental for the development of more effective and mechanism-based mind-body therapies. The potential for this research to positively impact public health is high, as breathing techniques are inexpensive, accessible, and cross-culturally accepted, with fewer complications then observed with other standard therapies for stress-related disorders.
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Affiliation(s)
- Helen Lavretsky
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California
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An Anti-hyperventilation Instruction Decreases the Drop in End-tidal CO 2 and Symptoms of Hyperventilation During Breathing at 0.1 Hz. Appl Psychophysiol Biofeedback 2020; 44:247-256. [PMID: 31065914 PMCID: PMC6685922 DOI: 10.1007/s10484-019-09438-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Breathing at a frequency of around 0.1 Hz is widely used in basic research and in applied psychophysiology because it strongly increases fluctuations in the cardiovascular system and affects psychological functioning. Volitional control of breathing often leads to hyperventilation among untrained individuals, which may produce aversive symptoms and alter the psychological and physiological effects of the paced breathing. The present study investigated the effectiveness of a brief anti-hyperventilation instruction during paced breathing at a frequency of 0.1 Hz. Forty-six participants were randomly assigned to one of two groups: a group given an anti-hyperventilation instruction and a control group without such an instruction. The instruction asked participants to avoid excessively deep breathing and to breathe shallowly and naturally. Participants performed the breathing task for 10 min. Hyperventilation was measured by partial pressure of end-tidal CO2 (PetCO2); furthermore, symptoms of hyperventilation, feeling of air hunger, task difficulty, and affective state were measured by self-report. The results showed that paced breathing without instruction decreased PetCO2 by 5.21 mmHg and that the use of the anti-hyperventilation instruction reduced the drop in PetCO2 to 2.7 mmHg. Symptoms of hyperventilation were lower in the group with the anti-hyperventilation instruction. Neither the feeling of air hunger nor task difficulty were affected by the instruction. There were no significant effects of the instruction on affective state. The present study indicates that a brief anti-hyperventilation instruction may be used to decrease drop in PetCO2 and symptoms of hyperventilation during breathing at 0.1 Hz and that the instruction is well tolerated.
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Paulus MP, Feinstein JS, Khalsa SS. An Active Inference Approach to Interoceptive Psychopathology. Annu Rev Clin Psychol 2020; 15:97-122. [PMID: 31067416 DOI: 10.1146/annurev-clinpsy-050718-095617] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Interoception refers to the process by which the nervous system senses and integrates signals originating from within the body, providing a momentary mapping of the body's internal landscape and its relationship to the outside world. Active inference is based on the premise that afferent sensory input to the brain is constantly shaped and modified by prior expectations. In this review we propose that interoceptive psychopathology results from two primary interoceptive dysfunctions: First, individuals have abnormally strong expectations of the situations that elicit bodily change (i.e., hyperprecise priors), and second, they have great difficulty adjusting these expectations when the environment changes (i.e., context rigidity). Here we discuss how these dysfunctions potentially manifest in mental illness and how interventions aimed at altering interoceptive processing can help the brain create a more realistic model of its internal state.
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Affiliation(s)
- Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, Oklahoma 74136, USA;
| | - Justin S Feinstein
- Laureate Institute for Brain Research, Tulsa, Oklahoma 74136, USA; .,Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma 74119, USA
| | - Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, Oklahoma 74136, USA; .,Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma 74119, USA
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Jamison AL, Slightam C, Bertram F, Kim S, Roth WT. Randomized clinical trial of capnometry-assisted respiratory training in veterans with posttraumatic stress disorder hyperarousal. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2019; 14:883-893. [PMID: 31804108 DOI: 10.1037/tra0000525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate whether capnometry-assisted antihyperventilation respiratory training, successful in treating panic, and sleep hygiene instructions would reduce posttraumatic stress disorder (PTSD) hyperarousal symptoms in U.S. military veterans. METHOD We conducted a parallel, nonblinded clinical trial and randomized 80 veterans with PTSD hyperarousal into treatment or wait list. Primary treatment outcomes from baseline to 1st follow-up were analyzed using mixed modeling. Baseline physiological measures were compared between the PTSD hyperarousal group and a no-PTSD group (n = 68). RESULTS Baseline respiration rate but not partial-pressure of end-tidal carbon dioxide (PCO₂) was higher in the PTSD hyperarousal group than in the no-PTSD group during 3 min of quiet sitting, indicating no difference in baseline hyperventilation. There was no significant effect of the intervention on PTSD hyperarousal symptoms or hyperventilation compared to wait list, but treatment did lower respiratory rate. CONCLUSION This intervention did not reduce PTSD hyperarousal symptoms, perhaps due to differences between underlying mechanisms of PTSD hyperarousal and panic disorder or to differences between veteran and civilian populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Szulczewski MT. Training of paced breathing at 0.1 Hz improves CO2 homeostasis and relaxation during a paced breathing task. PLoS One 2019; 14:e0218550. [PMID: 31220170 PMCID: PMC6586331 DOI: 10.1371/journal.pone.0218550] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/04/2019] [Indexed: 01/27/2023] Open
Abstract
Volitional control of breathing often leads to excessive ventilation (hyperventilation) among untrained individuals, which disrupts CO2 homeostasis and may elicit a set of undesirable symptoms. The present study investigated whether seven days of training without any anti-hyperventilation instructions improves CO2 homeostasis during paced breathing at a frequency of 0.1 Hz (6 breaths/minute). Furthermore, the present study investigated the effects of training on breathing-related changes in affective state to examine the hypothesis that training improves the influence of slow paced breathing on affect. A total of 16 participants performed ten minutes of paced breathing every day for seven days. Partial pressure of end-tidal CO2 (PetCO2), symptoms of hyperventilation, affective state (before and after breathing), and pleasantness of the task were measured on the first, fourth, and seventh days of training. Results showed that the drop in PetCO2 significantly decreased with training and none of the participants experienced a drop in PetCO2 below 30 mmHg by day seven of training (except one participant who already had PetCO2 below 30 mmHg during baseline), in comparison to 37.5% of participants on the first day. Paced breathing produced hyperventilation symptoms of mild intensity which did not decrease with training. This suggests that some participants still experienced a drop of PetCO2 that was deep enough to produce noticeable symptoms. Affective state was shifted towards calmness and relaxation during the second and third laboratory measurements, but not during the first measurement. Additionally, the breathing task was perceived as more pleasant during subsequent laboratory measurements. The obtained results showed that training paced breathing at 0.1 Hz led to decrease in hyperventilation. Furthermore, the present study suggests that training paced breathing is necessary to make the task more pleasant and relaxing.
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Khalsa SS, Feinstein JS, Simmons WK, Paulus MP. Taking Aim at Interoception's Role in Mental Health. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 3:496-498. [PMID: 29884279 DOI: 10.1016/j.bpsc.2018.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 04/19/2018] [Indexed: 10/14/2022]
Affiliation(s)
- Sahib S Khalsa
- Laureate Institute for Brain Research, and the Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma.
| | - Justin S Feinstein
- Laureate Institute for Brain Research, and the Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma
| | - W Kyle Simmons
- Laureate Institute for Brain Research, and the Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma
| | - Martin P Paulus
- Laureate Institute for Brain Research, and the Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma
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Ramirez JM, Baertsch N. Defining the Rhythmogenic Elements of Mammalian Breathing. Physiology (Bethesda) 2019; 33:302-316. [PMID: 30109823 DOI: 10.1152/physiol.00025.2018] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Breathing's remarkable ability to adapt to changes in metabolic, environmental, and behavioral demands stems from a complex integration of its rhythm-generating network within the wider nervous system. Yet, this integration complicates identification of its specific rhythmogenic elements. Based on principles learned from smaller rhythmic networks of invertebrates, we define criteria that identify rhythmogenic elements of the mammalian breathing network and discuss how they interact to produce robust, dynamic breathing.
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Affiliation(s)
- Jan-Marino Ramirez
- Center for Integrative Brain Research, Seattle Children's Research Institute, University of Washington School of Medicine , Seattle, Washington
| | - Nathan Baertsch
- Center for Integrative Brain Research, Seattle Children's Research Institute, University of Washington School of Medicine , Seattle, Washington
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15
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Khalsa SS, Adolphs R, Cameron OG, Critchley HD, Davenport PW, Feinstein JS, Feusner JD, Garfinkel SN, Lane RD, Mehling WE, Meuret AE, Nemeroff CB, Oppenheimer S, Petzschner FH, Pollatos O, Rhudy JL, Schramm LP, Simmons WK, Stein MB, Stephan KE, Van den Bergh O, Van Diest I, von Leupoldt A, Paulus MP. Interoception and Mental Health: A Roadmap. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2018; 3:501-513. [PMID: 29884281 PMCID: PMC6054486 DOI: 10.1016/j.bpsc.2017.12.004] [Citation(s) in RCA: 387] [Impact Index Per Article: 64.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/20/2017] [Accepted: 12/10/2017] [Indexed: 12/29/2022]
Abstract
Interoception refers to the process by which the nervous system senses, interprets, and integrates signals originating from within the body, providing a moment-by-moment mapping of the body's internal landscape across conscious and unconscious levels. Interoceptive signaling has been considered a component process of reflexes, urges, feelings, drives, adaptive responses, and cognitive and emotional experiences, highlighting its contributions to the maintenance of homeostatic functioning, body regulation, and survival. Dysfunction of interoception is increasingly recognized as an important component of different mental health conditions, including anxiety disorders, mood disorders, eating disorders, addictive disorders, and somatic symptom disorders. However, a number of conceptual and methodological challenges have made it difficult for interoceptive constructs to be broadly applied in mental health research and treatment settings. In November 2016, the Laureate Institute for Brain Research organized the first Interoception Summit, a gathering of interoception experts from around the world, with the goal of accelerating progress in understanding the role of interoception in mental health. The discussions at the meeting were organized around four themes: interoceptive assessment, interoceptive integration, interoceptive psychopathology, and the generation of a roadmap that could serve as a guide for future endeavors. This review article presents an overview of the emerging consensus generated by the meeting.
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Affiliation(s)
- Sahib S Khalsa
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma; Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma.
| | - Ralph Adolphs
- California Institute of Technology, Pasadena, California
| | - Oliver G Cameron
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Hugo D Critchley
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
| | - Paul W Davenport
- Department of Physiology, University of Florida, Gainesville, Florida
| | - Justin S Feinstein
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma; Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma
| | - Jamie D Feusner
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
| | - Sarah N Garfinkel
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
| | - Richard D Lane
- Department of Psychiatry, University of Arizona, Tucson, Arizona
| | - Wolf E Mehling
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Alicia E Meuret
- Department of Psychology, Southern Methodist University, Dallas, Texas
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, Florida
| | | | - Frederike H Petzschner
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich, Zurich, Switzerland
| | - Olga Pollatos
- Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Jamie L Rhudy
- Department of Psychology, University of Tulsa, Tulsa, Oklahoma
| | - Lawrence P Schramm
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Department of Neuroscience, Johns Hopkins University, Baltimore, Maryland
| | - W Kyle Simmons
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma; Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma
| | - Murray B Stein
- Department of Psychiatry, University of California, San Diego, San Diego, California
| | - Klaas E Stephan
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich, Zurich, Switzerland
| | | | - Ilse Van Diest
- Department of Health Psychology, University of Leuven, Leuven, Belgium
| | | | - Martin P Paulus
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma
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