The Panic Disorder Respiratory Ratio: A Dimensional Approach to the Respiratory Subtype

Freire, Rafael C.; Nascimento, Isabella; Valença, Alexandre Martins; Lopes, Fabiana L.; Mezzasalma, Marco A.; Neto, Valfrido Leão de Melo; Zin, Walter A.; Nardi, Antônio Egídio

doi:10.1016/j.rbp.2012.02.008

Cited by 7 publications

(9 citation statements)

References 30 publications

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“…As already mentioned, the amygdala is an important integrator that links emotions and respiration (Freire and Nardi, 2012), and an imbalance in amygdalar activity has been implicated in anxiety and panic disorders (Freire et al, 2013; Nardi et al, 2009). Using an in vitro approach, Onimaru and Homma reveal not only strong descending pathways to the respiratory network within the medulla, but also weak ascending pathways from the respiratory network to the amygdala (Fujii et al, 2010, 2011; Onimaru and Homma, 2007).…”

Section: Neuronal Structures and Neuromodulatory Mechanisms Linkinmentioning

confidence: 99%

The Integrative Role of the Sigh in Psychology, Physiology, Pathology, and Neurobiology

Ramirez

2014

Progress in Brain Research

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“Sighs, tears, grief, distress” expresses Johann Sebastian Bach in a musical example for the relationship between sighs and deep emotions. This review explores the neurobiological basis of the sigh and its relationship with psychology, physiology, and pathology. Sighs monitor changes in brain states, induce arousal, and reset breathing variability. These behavioral roles homeostatically regulate breathing stability under physiological and pathological conditions. Sighs evoked in hypoxia evoke arousal and thereby become critical for survival. Hypoarousal and failure to sigh have been associated with sudden infant death syndrome. Increased breathing irregularity may provoke excessive sighing and hyperarousal, a behavioral sequence that may play a role in panic disorders. Essential for generating sighs and breathing is the pre-Bötzinger complex. Modulatory and synaptic interactions within this local network and between networks located in the brainstem, cerebellum, cortex, hypothalamus, amygdala, and the periaqueductal gray may govern the relationships between physiology, psychology, and pathology. Unraveling these circuits will lead to a better understanding of how we balance emotions and how emotions become pathological.

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Section: Neuronal Structures and Neuromodulatory Mechanisms Linkinmentioning

confidence: 99%

The Integrative Role of the Sigh in Psychology, Physiology, Pathology, and Neurobiology

Ramirez

2014

Progress in Brain Research

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“…A timed, maximum-duration exhale test was used to assess participants' physiological tolerance to endogenous CO 2 as a metric of physiological stress response (52)(53)(54)(55)(56)(57)(58)(59). The single-item score reflects the exhale time in seconds, with higher scores indicating greater tolerance to endogenous CO 2 and physiological stress.…”

Section: Methodsmentioning

confidence: 99%

Slow-Breathing Curriculum for Stress Reduction in High School Students: Lessons Learned From a Feasibility Pilot

Bentley¹,

Seeber²,

Hightower³

et al. 2022

Front. Rehabilit. Sci.

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PurposeNearly one in three US adolescents meet the criteria for anxiety, an issue that has worsened with the COVID-19 pandemic. We developed a video-based slow diaphragmatic breathing stress-reduction curriculum for high school students and evaluated its feasibility, tolerability, and preliminary effectiveness.MethodsThis cluster-randomized feasibility pilot compared 5-min slow diaphragmatic breathing for 5 weeks with treatment-as-usual control among four 12th-grade public high school classes. Students individually participated after school during COVID-19-related hybrid teaching, with slow diaphragmatic breathing three times/week and breath science education once/week. Feasibility was based on completion of breathing exercises, breath science education, and preliminary effectiveness assessments, and ease/tolerability was based on qualitative assessments. Preliminary effectiveness was measured with the State-Trait Anxiety Inventory (STAI) and a timed-exhale carbon dioxide tolerance test (CO2TT) of physiological stress response. Descriptive statistics and repeated analysis of variance were performed to quantify and compare outcomes between time periods. Human subjects research approval was granted through Western IRB–Copernicus Group (WCG IRB) [ClinicalTrials.gov, Identifier: NCT05266833.]ResultsForty-three students consented to participate. Breath practice compliance ranged from 29 to 83% across classes and weeks, and decreased on average over the 5 weeks. Compliance with the breath science videos ranged from 43 to 86%, and that with the weekly STAI-State and CO2TT measures varied from 36 to 86%. Compliance with ease/tolerability assessments ranged from 0 to 60%. Preliminary effectiveness assessments' compliance varied across classes from 83 to 89% during baseline, and 29 to 72% at follow-up. The curriculum was rated as somewhat-to-definitely useful/beneficial, and definitely-to-very easy/tolerable. Students reported enjoying the diaphragmatic breathing, CO2TT, and breath science education; some found the extended exhales challenging and the curriculum and assessments time-consuming. Preliminary effectiveness analyses indicated no significant changes in STAI or CO2TT from baseline to followup or from before to after breathing exercises (p > 0.05 for all).ConclusionsImplementation of this 5-week slow breathing curriculum was feasible and tolerable to this cohort. Compliance, tolerability, and effectiveness may be improved with in-class participation. Future research on simple and accessible slow-breathing exercises is warranted to address today's adolescent stress-management crisis.Trial RegistrationClinicalTrials.gov, Identifier: NCT05266833

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“…The present editorial, stimulated by two articles appearing in Revista Brasileira de Psiquiatria, 2,3 reflects on other problems. A major difficulty is the definition of panic, since this word has different referents in everyday usage, depending on the context.…”

mentioning

confidence: 92%

“…Freire et al 3 hoped that the proportion of diaryspecified symptomatic ''respiratory'' complaints would predict carbon dioxide-induced panic, and found a significant correlation of 0.33. However, this is far below the level necessary to be scientifically useful.…”

mentioning

confidence: 99%

Difficulties in panic studies

Klein

2013

Rev. Bras. Psiquiatr.

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The Panic Disorder Respiratory Ratio: A Dimensional Approach to the Respiratory Subtype

Abstract: The positive correlation between the respiratory ratio and the anxiety elicited by the CO₂ inhalation indicates that the intensity of respiratory symptoms may be proportional to the sensitivity to carbon dioxide.

Cited by 7 publications

References 30 publications

The Integrative Role of the Sigh in Psychology, Physiology, Pathology, and Neurobiology

The Integrative Role of the Sigh in Psychology, Physiology, Pathology, and Neurobiology

Slow-Breathing Curriculum for Stress Reduction in High School Students: Lessons Learned From a Feasibility Pilot

Difficulties in panic studies

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