The Impact of Respiratory Biofeedback Use on Symptom Severity in Panic Disorder

Year 2025, Volume: 12 Issue: 1, 1 - 7, 28.03.2025

Hatice Yıldız Burkovik , Buse Sıdıka Göçmen , Barış Metin

https://doi.org/10.32739/jnbs.12.1.1

Abstract

Aim: This study aimed to enhance conscious awareness of respiratory control in panic disorder patients to prevent panic attacks. Materials and Method: Thirty participants (aged 18–65) diagnosed with panic
disorder were recruited from NP Istanbul Brain Hospital and NP Istanbul Medical Center. They were divided into two groups: one received only psychoeducation on breathing techniques, while the other
received psychoeducation combined with visual biofeedback (Galvanic Skin Resistance, heart rate, respiratory depth, and skin temperature). Breathing training was conducted over four weeks, and outcomes were assessed using the Panic Agoraphobia Scale, State and Trait Anxiety Scale, and biofeedback metrics. Result: Both groups showed significant improvements in Panic Agoraphobia Scale scores and reductions in State and Trait Anxiety scores. The biofeedback group demonstrated more pronounced improvements in respiratory control, with significantly lower breathing rates in the final assessment. Conclusion: Respiratory biofeedback combined with psychoeducation effectively improves respiratory control and reduces anxiety symptoms in panic disorder patients.

Keywords

Panic Disorder, Respiratory Biofeedback, anxiety

Ethical Statement

Non-Interventional Research Ethics Committee permission was received from Uskudar University with approval date 25.04.2019 and number 61351342-/2019-278.

Supporting Institution

Yok

Thanks

Teşekkürler

References

• 1. Kessler RC., Avenevoli, S., Costello, E.J. Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the Na¬tional Comorbidity Survey Replication Adolescent Supplement. Arch Gen Psychiatry, 2012;69(4):372–380. doi:10.1001/archgenpsychia¬try.2011.160
• 2. Bandelow MS, Michaelis S. Epidemiology of anxiety disorders in the 21st century. Diaoluges Clin Neurosci, 2015;17(3):327-335. DOI: 10.31887/ DCNS.2015.17.3/bbandelow
• 3. Chisholm D, Sweeny K, Sheehan P. Scaling-up treatment of de¬pression and anxiety: a global return on investment analysis. Lancet Psychiatry, 2016;3(5):415–424. DOI:https://doi.org/10.1016/S2215- 0366(16)30024-4
• 4. Kroenke KS. Anxiety disorders in primary care: prevalence, im¬pairment, comorbidity, and detection. Annals of internal medicine, 2007;146(5), 317-325.
• 5. Carta MG, Moro MF, Aguglia E. The attributable burden of panic disor¬der in the impairment of quality of life in a national survey in Italy. Int J Soc Psychiatry, 2015;61:693–699. DOI: 10.1177/0020764015573848
• 6. Hayashi KM. Electroencephalogram abnormalities in panic disorder patients: a study of symptom characteristics and pathology. BioPsy¬choSocial medicine, 2010;4(1),9.
• 7. Kaiya H, Umekage T. Factors associated with the development of pan¬ic attack and panic disorder: Survey in Japanese population. Psychi¬atry Clin Neurosci, 2005;59:177-182. https://doi.org/10.1111/j.1440- 1819.2005.01354.x
• 8. Smoller JW, Gardner-Schuster E. The genetic basis of panic and pho¬bic anxiety disorders. Am J Med Genet Part C, 2010;148:118–126. https://doi.org/10.1002/ajmg.c.30174
• 9. Uchida R, Del-Ben CM. Decreased left temporal lobe volume of panic patients measured by magnetic resonance imaging. Braz J Med Biol Res, 2003;36:925–929. https://doi.org/10.1590/S0100- 879X2003000700014
• 10. Sibille E. Genetic inactivation of the serotonin1A receptor in mice results in downregulation of major GABAA receptor α subunits, re¬duction of GABAA receptor binding, and benzodiazepine-resistant anxiety. https://doi.org/10.1523 JNeurosci, 2000;20:2758–2765.
• 11. Critchley HD, Wiens S, Rotshtein P. Neural systems supporting in¬teroceptive awareness. Nat Neurosci, 2004;189–195. doi10.1038/ nn1176
• 12. Tunnell NR. Habituation or normalization through treatment? Expe¬riential and respiratory recovery from voluntary hyperventilation in treated versus untreated patients with panic disorder. Behavior Thera¬py, 2020;52(1):124-125. doi: 10.1016/j.beth.2020.03.003
• 13. Yamada T. Recovery of percent vital capacity by breathing train¬ing in patients with panic disorder and impaired diaphragmatic breathing. Behavior Modification, 2017;41(5):665-682. https://doi. org/10.1177/0145445517711436
• 14. de Jonge P, Roest AM, Lim CCW. Cross-national epidemiology of panic disorder and panic attacks in the world mental health surveys. Depress Anxiety, 2016;33(12):1155–77. DOI 10.1017/9781316336168.007
• 15. Tural UF. Validity and reliability of the Turkish version of the Panic and Agoraphobia Scale. Turk Psikiyatri Derg, 2000;11(1):29-39.
• 16. Spielberger C. Manual ForState-TraitAnxiety Inventory, Paloalto, California: Consulting Psychologists, 1970.
• 17. Öner L, Le compte A. Durumluk-Sürekli Kaygı Envanteri El Kitabı, Boğaziçi, Istanbul, 1998.
• 18. Richards BK. Brief Internet-Based Treatment For Panic Disorder. Behav. Cogn. Psychother, 2001; 29(1):113–117. DOI: 10.1017/ S1352465801001138
• 19. Yoonessi, A., Ekhtiari, H. Text messages as a tool for assessing pub¬lic concern about drug problems.IntJDrugPolicy,2013.24(6):624–627. https://doi.org/10.1016/j.drugpo.2013.06.002
• 20. Bossema, E.R., de Haar C.A.J., Westerhuis, W. (2011). Psychoedu¬cation for patients with a psychotic disorder: effects on knowledge and coping. Prim Care Companion CNS Disord, 13(4):213–223 :doi:10.4088/PCC.10m01116
• 21. Bonn JA. Enhanced behavioral response in agoraphobic patients pretreated with breathing retraining. Lancet, 1984;2:665-669. DOI: https://doi.org/10.1016/S0140-6736(84)91226-1
• 22. Meuret AE. Respiratory biofeedback-assisted therapy in panic dis¬order. Behavior Modification, 2001;25(4):584-605. https://doi. org/10.1177/0145445501254006
• 23. Goodwin EA. A cognitive-behavioral, biofeedback-assisted relaxation treatment for panic disorder with agoraphobia. Clinical Case Stud¬ies,2006;5(2):112-125. https://doi.org/10.1177/1534650103261212
• 24. Tunnell NC. Habituation or Normalization? Experiential and Re¬spiratory Recovery From Voluntary Hyperventilation in Treated Versus Untreated Patients With Panic Disorder. Behavior Therapy, 2021;52(1):124-135. https://doi.org/10.1016/j.beth.2020.03.003