This study will explore respiratory dysregulation in anxious outpatients and examine the
effect of breathing training with biofeedback for those anxious patients.
In clinic testing and outside the clinic testing, we will assess the prevalence of
respiratory dysregulation in a sample of 60 non-psychotic, not currently alcohol or drug
abusing veteran outpatients from our MHC (Mental Hygiene Clinic) who experience episodic
anxiety but who do not qualify and have never qualified for the diagnosis of PD (panic
disorder). These patients will be compared to 30 patients who are not clinically anxious.
Of these 60 anxious patients, 30 will be randomly assigned to a 4-week course of breathing
training assisted by feedback of end-tidal pCO2 levels as an augmentation of their current
treatment. They will be compared to 30 who simply will continue with their current treatment
(TAU). The breathing training group will receive clinical and physiological assessments
immediately before the treatment period, four weeks after the end of the treatment period,
and at a 4-month follow-up. The TAU group will be assessed three times at equivalent
intervals, and if they wish, may undergo breathing training after the third assessment.
Treatment will take place mainly in the first two years, giving us adequate time for
follow-up and data analysis. We expect that this therapy will be especially effective for
treating anxiety in the patients with substantial respiratory dysregulation.
- Patients must be rated 2 or more on both Q1 and Q3, but they must not meet the full
criteria for PD as determined by the Anxiety Disorders Interview Schedule for
DSM-IV-Lifetime Version (ADIS).
- In addition, they must be clinically stable enough that changes in the patients'
anxiety levels can be attributed to the breathing training rather than to other new
treatment initiatives during the training and 1-month evaluation periods or to
spontaneous fluctuations in anxiety levels. Thus, potential participants taking SSRIs
or other antidepressants, or benzodiazepines have to have been on a stable dose of
these medicines for at least the previous two months.
- Potential participants taking short-acting benzodiazepines such as alprazolam in
excess of 2.0 mg/day or the equivalent on any day in the past month are excluded,
because improvement might show up only in terms of reduction of medication dosage and
not on the evaluation measures planned.