Rescuing the Hyperventilation Theory of Panic: Reply to Ley (2005) (original) (raw)
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The role of hyperventilation in panic disorder: a response to Ley (1991)
Behaviour Research and Therapy, 1992
First, Ley indicated that we were mistaken in our application of a two-tailed f-test when testing the hypothesis that breathing retraining plus cognitive restructuring would lead to a decrease in frequency of panic attacks. Our two-tailed t of 1.82 (d.f. = 11) was nonsignificant at an a level of 0.05, but Ley's one-tailed t of 1.82 (d.f. = 11) did reach the 0.05 level of significance. His criticism on this point is valid-a directional hypothesis calls for a directional test. However, we wish to point out that the efficacy of BRCR is rather limited when the remaining self-report outcome measures are considered. Of 8 self-report scales measuring psychological distress (agoraphobic fear and avoidance, general anxiety, depression, somatic complaints), only the scale assessing fear of bodily sensations shows a significant decrease from pre-to posttherapy [t(ll) = 2.13, P < 0.05, one-tailed; see in de Ruiter et al., 19891. Second, Ley discusses our finding that the BRCR treatment has led to a decreased respiratory rate (RR) and a decline in end tidal pC0, (petC0,).
Role of hyperventilation in panic disorder: a response to Ley (1991)
Behav Res Ther, 1992
First, Ley indicated that we were mistaken in our application of a two-tailed f-test when testing the hypothesis that breathing retraining plus cognitive restructuring would lead to a decrease in frequency of panic attacks. Our two-tailed t of 1.82 (d.f. = 11) was nonsignificant at an a level of 0.05, but Ley's one-tailed t of 1.82 (d.f. = 11) did reach the 0.05 level of significance. His criticism on this point is valid-a directional hypothesis calls for a directional test. However, we wish to point out that the efficacy of BRCR is rather limited when the remaining self-report outcome measures are considered. Of 8 self-report scales measuring psychological distress (agoraphobic fear and avoidance, general anxiety, depression, somatic complaints), only the scale assessing fear of bodily sensations shows a significant decrease from pre-to posttherapy [t(ll) = 2.13, P < 0.05, one-tailed; see in de Ruiter et al., 19891. Second, Ley discusses our finding that the BRCR treatment has led to a decreased respiratory rate (RR) and a decline in end tidal pC0, (petC0,).
Are Current Theories of Panic Falsifiable?.
Psychological bulletin, 2005
The authors examine 6 theories of panic attacks as to whether empirical approaches are capable of falsifying them and their heuristic value. The authors conclude that the catastrophic cognitions theory is least falsifiable because of the elusive nature of thoughts but that it has greatly stimulated research and therapy. The vicious circle theory is falsifiable only if the frightening internal sensations are specified. The 3-alarms theory postulates an indeterminate classification of attacks. Hyperventilation theory has been falsified. The suffocation false alarm theory lacks biological parameters that unambiguously index dyspnea or its distinction between anticipatory and panic anxiety. Some correspondences postulated between clinical phenomena and brain areas by the neuroanatomical hypothesis may be falsifiable if panic does not depend on specific thoughts. All these theories have heuristic value, and their unfalsifiable aspects are capable of modification.
Panic disorder and hyperventilation
Arquivos De Neuro-psiquiatria, 1999
Respiratory abnormalities are associated with anxiety, particularly with panic attacks. Symptoms such as shortness of breath, "empty-head" feeling, dizziness, paresthesias and tachypnea have been described in the psychiatric and respiratory physiology related to panic disorder. Panic disorder patients exhibit both behaviorally and physiologically abnormal responses to respiratory challenges tests. Objective: We aim to observe the induction of panic attacks by hyperventilation in a group of panic disorder patients (DSM-IV). Method: 13 panic disorder patients and 11 normal volunteers were randomly selected. They were drug free for a week. They were induced to hyperventilate (30 breaths/min) for 3 minutes. Anxiety scales were taken before and after the test. Results: 9 (69.2%) panic disorder patients and one (9.1%) of control subjects had a panic attack after hyperventilating (p< 0.05). Conclusion: The panic disorder group was more sensitive to hyperventilation than normal volunteers. The induction of panic attacks by vonluntary hyperventilation may be a useful and simple test for validating the diagnosis in some specific panic disorder patients.
Western Historical Perspectives Of Panic Disorder - An Overview
2022
This article deals about essential parts of the history of an idea of the panic disorder and show how vital its opinion is for clinical and research progress. Several stories and works of fiction have talked about panic disorder, an ancient examples is the Greek God Pan, from whom we derive the word "panic." The medical approach reached its peak in the first half of the 19th century and in the second half of the 19th century, anxiety symptoms began to change slowly but steadily. In the 20th century it was stated by Mayer-Gross (1954) that panic disorder was caused by genetic, biological, and psychological factors. Anxiety was divided into phobic and straightforward nervous states. In 1964, Donald Klein stated that tricyclic antidepressants like imipramine helped people with these disorders. There was also therapeutic growth in the fields of psychopharmacology and psychotherapy. "The Diagnostic and Statistical Manual of Mental Disorders" was changed by what he observed and said. For the first time ever, a list published by the officials used the phrase "panic disorder." During the most recent few decades of the 20th century, there was a lot of discussion about some biological theories about etiology. Some of them like The "False Suffocation Alarm Theory," written by Donald Klein in 1993, and the Fear Network. These theories are accepted based on studies in cognitive, breathing, thinking, physiology, biochemistry, and lab work tests. In the last 80 years, basic and clinical research has helped us figure out panic disorders that have changed over time and how resultant treatments have changed.
The role of hyperventilation: hypocapnia in the pathomechanism of panic disorder
Revista Brasileira De Psiquiatria, 2007
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.
Brazilian Journal of Medical and Biological Research, 2004
Our aim was to compare the clinical features of panic disorder (PD) patients sensitive to hyperventilation or breath-holding methods of inducing panic attacks. Eighty-five PD patients were submitted to both a hyperventilation challenge test and a breath-holding test. They were asked to hyperventilate (30 breaths/min) for 4 min and a week later to hold their breath for as long as possible, four times with a 2-min interval. Anxiety scales were applied before and after the tests. We selected the patients who responded with a panic attack to just one of the tests, i.e., those who had a panic attack after hyperventilating (HPA, N = 24, 16 females, 8 males, mean age ± SD = 38.5 ± 12.7 years) and those who had a panic attack after breath holding (BHPA, N = 20, 11 females, 9 males, mean age ± SD = 42.1 ± 10.6 years). Both groups had similar (χ 2 = 1.28, d.f. = 1, P = 0.672) respiratory symptoms (fear of dying, chest/pain disconfort, shortness of breath, paresthesias, and feelings of choking) during a panic attack. The criteria of Briggs et al.
The Etiology and Treatment of Panic Disorders
Mammals, especially prey animals, respond immediately to threats. Mammals have sophisticated vascular systems that allow the body to moderate the flow of blood to manage different needs (Cannon, 1963). During fight-flight, vasoconstriction will essentially reroute the blood from the non-essential organs to the large muscle systems in order to make more oxygen available, and increase the volume of blood movement to allow greater oxygen exchange (Cannon, 1963). Oxygen is critical to the synthesis of lactic acid in the muscles for continued contraction. A threat can mobilize the tremendous latent capacity in the lungs and vascular system. We can trigger some of these reactions merely by thinking about increased activity, which prepares the body’s response to meet the potential need (Cannon, 1963). Many of the body’s survival responses – homeostasis of the blood sugar levels, oxygen supply, and acid-base reactions – are connected to the emotions of fear and rage as precursors for fight-flight responses (Cannon, 1963). They all serve to render the body to be more effective in the “violent display of energy which fear and rage may involve” (Cannon, 1963, p. 228). With fear, there is an object attached to the fear. We can meet the object, attempt to remove the object or we can attempt to escape the object (Goldstein, 1995). The cause of the fear exists in some sense. Anxiety, however, has no object we can relate to (Goldstein, 1995). What is more, if there is no object of the threat, there is no defense, and no safety.
On distinguishing types of panic
Journal of Anxiety Disorders, 1996
Ah&act-Ninety-four patients with panic disorder and agoraphobia monitored 1276 panic attacks before and during treatment. The prevalence of various types of panic attacks was investigated as well as differences in severity between types of attacks. Most attacks were judged by the patients as expected and occurred in a threatening situation (50%); only a minority of all attacks (17%) was rated as unexpected and nonsituational Requests for reprints should be sent to Bert Garssen,