Respiratory Training in the Treatment of Transdiagnostic Pathological Anxiety

Low end-tidal CO2 (ETCO2), which is an accompanying feature of hyperventilation, has been associated with a variety of anxiety disorders, including panic disorder and social phobia. More recently, researchers have examined the efficacy of capnometry-guided respiratory intervention (CGRI) as a method for increasing ETCO2 and thereby reducing hyperventilation-induced anxiety/panic symptoms. Promising preliminary efficacy studies have shown that CGRI results in decreased panic symptom frequency and severity at a rate comparable to that of cognitive therapy. A recent uncontrolled proof-of-concept study showed that CGRI led to significant reductions in trauma symptoms in a sample of patients meeting DSM-5 criteria for PTSD. However, CGRI has not been adequately evaluated in the treatment of anxiety disorders other than panic disorder with or without agoraphobia.

Inclusion criteria

• Clinically elevated anxiety as indicated by an eight or higher on the Overall Anxiety Severity and Impairment Scale (OASIS).
• Meets DSM-5 criteria for one or more of the following anxiety or trauma-related disorders as their "primary" mental disorder:

• Generalized Anxiety Disorder
• Panic Disorder
• Health Anxiety
• Agoraphobia
• Social Anxiety Disorder
• Posttraumatic Stress Disorder
• Acute Stress Disorder
• Adjustment Disorder with primary anxious mood
• Anxiety disorder not otherwise specified
• No current use of psychotropic medications or stable on current medications for at least 6 weeks
• Age 18+.
• Able to arrange transportation to our laboratory for study appointments.
• Fluent in English.

Exclusion criteria

• No history of medical conditions that would contraindicate participation in fear-provocation or respiratory challenges, including:

• Cardiovascular or respiratory disorders
• High blood pressure
• Epilepsy
• Strokes
• Seizures
• History of fainting
• Pregnant or lactating
• Not currently receiving other psychological treatment for anxiety.
• No history of a suicide attempt within the past 6 months.
• No history of psychosis within the past 6 months.
• No history of moderate to severe alcohol or substance use disorder (with the exception of nicotine) within the past 3 months.
• Does not endorse COVID-19 symptoms during the screening phase.