van den Hout M A, De Jong P, Zandbergen J, Merckelbach H
Department of Mental Health Sciences/Experimental Psychopathology, Limburg University, Maastricht, The Netherlands.
Behav Res Ther. 1990;28(5):445-8. doi: 10.1016/0005-7967(90)90165-f.
Recent theories about panic emphasize that a hyperventilatory positive feedback loop is involved in panic: catastrophic misinterpretation of bodily sensations may trigger anxiety, anxiety may stimulate hyperventilation, hyperventilation may promote the salience of feared sensations etc. Such models leave unexplained how and when panics come to an end. It was hypothesised that panic with hyperventilation may end because pronounced hyperventilation becomes, in the course of time, less powerful in generating perceivable bodily sensations. Twenty healthy subjects hyperventilated forcefully and experienced clear panic symptoms as defined by DSM IIIR. When pCO2 was kept 55% below base line for 90 min, panic symptoms waned. The mean intensity of the symptoms declined as did the number of symptoms occurring. No panic symptoms were observed in the control group (n = 20) who ventilated normally. In so far as hyperventilation is involved in the positive feedback loops that characterize panic, panic attacks may be time-limited because sensations induced by hyperventilation become less salient even if massive hyperventilation continues. As to the explanation of the reported phenomenon, it is suggested that, apart from habituation, local physiological changes due to prolonged hyperventilation may produce a decrease in interoceptive input.
近期关于惊恐发作的理论强调，惊恐发作涉及一个过度通气的正反馈循环：对身体感觉的灾难性错误解读可能引发焦虑，焦虑可能刺激过度通气，过度通气可能使恐惧的感觉更加突出等等。这类模型没有解释惊恐发作是如何以及何时结束的。有人提出，伴有过度通气的惊恐发作可能会结束，因为随着时间的推移，明显的过度通气在产生可感知的身体感觉方面变得不那么强烈了。20名健康受试者进行了强力过度通气，并体验到了《精神疾病诊断与统计手册》第三版修订本（DSM IIIR）所定义的明显惊恐症状。当呼气末二氧化碳分压（pCO2）保持在基线以下55%达90分钟时，惊恐症状逐渐减弱。症状的平均强度以及出现的症状数量均有所下降。在正常通气的对照组（n = 20）中未观察到惊恐症状。就过度通气参与惊恐发作所特有的正反馈循环而言，惊恐发作可能是有时间限制的，因为即使持续大量过度通气，过度通气所诱发的感觉也会变得不那么明显。至于对所报道现象的解释，有人认为，除了习惯化之外，长时间过度通气引起的局部生理变化可能会导致内感受性输入减少。
