Breathing retraining biofeedback device eases panic symptoms in adolescents

Use of a breathing retraining biofeedback device has been shown to ameliorate panic symptoms in children, particularly among those aged 13 to 17 years, reports a study presented at PAS 2023.

The device features a capnometer that allows individuals to regulate their own carbon dioxide outflow to achieve a steady level of 40 mm Hg, with breathing exercises taking place twice a day for 17 minutes over 28 days. [M Bhimani, et al, PAS 2023]

“The breathing retraining was found to be effective in reducing panic symptom scores, especially in older adolescents, potentially correlating to the increased incidence of panic disorder among adolescents,” said the researchers, led by Muskaan Bhimani of the Iiaquat University of Medical and Health Science Jamshoro in Sindh, Pakistan.

Bhimani and colleagues conducted a randomized clinical trial to test the efficacy of a breathing retraining biofeedback device. They randomly assigned participants 9 to 17 years of age to the device or to a waitlist control and did follow-up through weekly phone calls and office visits at baseline, week 4, and week 8 for device users and at baseline and week 8 for controls.

During follow-up, the researchers assessed panic symptoms using the Panic Disorder Severity Scale for Adolescents, a 7-item self-reporting questionnaire. They also used the Children’s Depression Index (CDI) to control for depressive symptoms. Finally, the effects of the breathing retraining device and the control groups on panic symptoms were calculated using generalized linear models.

At week 8, 50 participants showed improvements as seen in the decrease in their panic symptoms, but only device users achieved statistical significance. Notably, week 8 was the time frame in which breathing retraining reached its maximum effect (coefficient, ‒2.9; p=0.001) when compared to baseline. Control participants also improved but did not reach significance (coefficient, ‒1.68; p=0.07).

Sub-analysis by age (9‒12 years; 13‒17 years) revealed that older adolescents who received active treatment demonstrated significant improvements in panic disorder symptoms at week 8 (coefficient, ‒4.47; p<0.001). Improvements in the younger group did not attain significance.

In addition, the researchers observed mild to severe depression in all participants using the CDI scale at baseline. However, they saw no change in their analysis when using depression as a confounding factor in the investigation.

“The analysis used to compare cases and controls at baseline, [weeks] 4 and 8 showing no difference suggests that the placebo phone calls had some impact on improving the panic disorder symptoms in the waitlist control group,” the researchers said.

Patients with panic disorders often experience shortness of breath or other respiratory complaints. Such symptoms have been used as evidence for hyperventilation and false suffocation alarm theories of panic. A common solution to this problem is to train patients to alter their breathing patterns. [J Clin Psych 2004;60:197-207]

“Anxiety disorders are highly prevalent in youth,” the researchers said. “Treatments include psychotherapy and medication approaches, but these are often difficult to access or cause side effects.”