Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA.
J Clin Psychiatry. 2012 Jul;73(7):931-9. doi: 10.4088/JCP.11m07068.
Teaching anxious clients to stop hyperventilating is a popular therapeutic intervention for panic. However, evidence for the theory behind this approach is tenuous, and this theory is contradicted by an opposing theory of panic, the false-suffocation alarm theory, which can be interpreted to imply that the opposite would be helpful.
To test these opposing approaches by investigating whether either, both, or neither of the 2 breathing therapies is effective in treating patients with panic disorder.
We randomly assigned 74 consecutive patients with DSM-IV-diagnosed panic disorder (mean age at onset = 33.0 years) to 1 of 3 groups in the setting of an academic research clinic. One group was trained to raise its end-tidal P(CO₂) (partial pressure of carbon dioxide, mm Hg) to counteract hyperventilation by using feedback from a hand-held capnometer, a second group was trained to lower its end-tidal P(CO₂) in the same way, and a third group received 1 of these treatments after a delay (wait-list). We assessed patients physiologically and psychologically before treatment began and at 1 and 6 months after treatment. The study was conducted from September 2005 through November 2009.
Using the Panic Disorder Severity Scale as a primary outcome measure, we found that both breathing training methods effectively reduced the severity of panic disorder 1 month after treatment and that treatment effects were maintained at 6-month follow-up (effect sizes at 1-month follow-up were 1.34 for the raise-CO(2) group and 1.53 for the lower-CO(2) group; P < .01). Physiologic measurements of respiration at follow-up showed that patients had learned to alter their P(CO₂) levels and respiration rates as they had been taught in therapy.
Clinical improvement must have depended on elements common to both breathing therapies rather than on the effect of the therapies themselves on CO(2) levels. These elements may have been changed beliefs and expectancies, exposure to ominous bodily sensations, and attention to regular and slow breathing.
ClinicalTrials.gov identifier: NCT00183521.
教授焦虑的客户停止过度通气是治疗惊恐症的一种流行的治疗干预方法。然而，这种方法背后的理论依据并不充分，并且该理论与惊恐症的另一种对立理论，即假性窒息警报理论相矛盾，该理论可以被解释为暗示相反的方法会有所帮助。
通过调查两种呼吸疗法中的任何一种、两种或都没有，是否对惊恐障碍患者有效，来检验这些对立的方法。
我们在学术研究诊所的环境中，将 74 名连续确诊为 DSM-IV 诊断的惊恐障碍患者（发病时的平均年龄为 33.0 岁）随机分配到 3 组中的 1 组。一组通过使用手持式二氧化碳监测仪反馈来训练提高其呼气末 P（CO₂）（二氧化碳分压，mmHg）以对抗过度通气，另一组以同样的方式训练降低其呼气末 P（CO₂），第三组在延迟（等待名单）后接受其中一种治疗。我们在治疗开始前、治疗后 1 个月和 6 个月对患者进行生理和心理评估。研究于 2005 年 9 月至 2009 年 11 月进行。
使用惊恐障碍严重程度量表作为主要结局测量指标，我们发现两种呼吸训练方法都能有效地减轻惊恐障碍的严重程度，并且治疗效果在 6 个月随访时得以维持（1 个月随访时的效果大小为升高 CO₂组为 1.34，降低 CO₂组为 1.53；P<.01）。随访时的呼吸生理测量显示，患者已经学会按照治疗中教授的方法改变他们的 P（CO₂）水平和呼吸频率。
临床改善必须取决于两种呼吸疗法共有的元素，而不是疗法本身对 CO₂水平的影响。这些元素可能是改变信念和预期、暴露于不祥的身体感觉以及关注有规律和缓慢的呼吸。
ClinicalTrials.gov 标识符：NCT00183521。
