Psychological treatment of comorbid asthma and panic disorder in Latino adults: Results from a randomized controlled trial

Abstract

Confusion between panic and asthma symptoms can result in serious self-management errors. A cognitive behavior psychophysiological therapy (CBPT) intervention was culturally adapted for Latinos consisting of CBT for panic disorder (PD), asthma education, differentiation between panic and asthma symptoms, and heart rate variability biofeedback. An RCT compared CBPT to music and relaxation therapy (MRT), which included listening to relaxing music and paced breathing at resting respiration rates. Fifty-three Latino (primarily Puerto Rican) adults with asthma and PD were randomly assigned to CBPT or MRT for 8 weekly sessions. Both groups showed improvements in PD severity, asthma control, and several other anxiety and asthma outcome measures from baseline to post-treatment and 3-month follow-up. CBPT showed an advantage over MRT for improvement in adherence to inhaled corticosteroids. Improvements in PD severity were mediated by anxiety sensitivity in CBPT and by depression in MRT, although earlier levels of these mediators did not predict subsequent improvements. Attrition was high (40%) in both groups, albeit comparable to CBT studies targeting anxiety in Latinos. Additional strategies are needed to improve retention in this high-risk population. Both CBPT and MRT may be efficacious interventions for comorbid asthma-PD, and CBPT may offer additional benefits for improving medication adherence.

How does anxiety sensitivity increase risk of chronic medical conditions?

“…In support of this theory, AS‐physical concerns predict poorer asthma control (e.g., the frequency of symptoms and impairment due to symptoms) among young adults with asthma (McLeish, Zvolensky, & Luberto, ). Additionally, a CBT intervention in part designed to help patients differentiate between asthma and panic symptoms among adults with comorbid asthma and panic disorder led to both significant improvements in asthma control and reductions in panic symptoms (Feldman et al., ), perhaps suggesting that greater understanding of respiratory symptoms may play an important role in the reduction in reactivity to both panic and asthma.…”

Emotionally triggered asthma and its relationship to panic disorder, ataques de nervios, and asthma-related death of a loved one in Latino adults

“…Future studies should also investigate whether death of a loved one due to asthma and similar asthma-specific negative life events are predictive of poorer asthma control, asthma morbidity, and health-related quality of life among Latino patients. Finally, longitudinal research is needed to determine whether cognitive-behavioral protocols for asthma and anxiety [39, 57] promote self-efficacy in the specific context of these psychosocial stressors, thereby improving asthma outcomes in Latino patients with ataques de nervios and comorbid psychological conditions such as PD.…”

“…Participants were self-reported asthma patients assessed for eligibility for a larger intervention study of Latinos with asthma and PD[39]. The current study included 292 adults recruited from asthma clinics in the Bronx, NY, 79.5% ( n = 235) of whom were female.…”

Exposure‐based cognitive behavior therapy for anxiety related to asthma: A feasibility study with multivariate baseline design

“…However, the limited number of trials and methodological limitations (e.g., high variability in interventions and delivery, underpowered samples and large drop‐out rates) impedes conclusions on treatment efficacy (Kew et al ., 2016; Pateraki & Morris, 2018). Furthermore, the CBT investigated have mainly targeted panic disorder and does not address the broader range of increased anxiety related to asthma (Feldman, Matte, Interian et al ., 2016; Lehrer, Karavidas, Lu et al ., 2008; Ross, Davis & Macdonald, 2005), which has been suggested to be important (Thoren & Petermann, 2000). A broad inclusion is further supported by experimental studies demonstrating that fear of asthma is enough to over‐perceive asthma symptoms (Janssens, Verleden, De Peuter, Petersen & Van den Bergh, 2011; Janssens, Verleden, De Peuter, Van Diest & Van den Bergh, 2009).…”