A Multisite Benchmarking Trial of Capnometry Guided Respiratory Intervention for Panic Disorder in Naturalistic Treatment Settings

Appl Psychophysiol Biofeedback. 2017 Mar;42(1):51-58. doi: 10.1007/s10484-017-9354-4.


Panic disorder (PD) is associated with hyperventilation. The efficacy of a brief respiratory feedback program for PD has been established. The aim of the present study was to expand these results by testing a similar program with more clinically representative patients and settings. Sixty-nine adults with PD received 4 weeks of Capnometry Guided Respiratory Intervention (CGRI) using Freespira, which provides feedback of end-tidal CO2 (PETCO2) and respiration rate (RR), in four non-academic clinical settings. This intervention is delivered via home use following initial training by a clinician and provides remote monitoring of client adherence and progress by the clinician. Outcomes were assessed post-treatment and at 2- and 12-month follow-up. CGRI was associated with an intent-to-treat response rate of 83% and a remission rate of 54%, and large decreases in panic severity. Similar decreases were found in functional impairment and in global illness severity. Gains were largely sustained at follow-up. PETCO2 moved from the slightly hypocapnic range to the normocapnic range. Benchmarking analyses against a previously-published controlled trial showed very similar outcomes, despite substantial differences in sample composition and treatment settings. The present study confirms prior clinical results and lends further support to the viability of CGRI in the treatment of PD.

Keywords: Biofeedback; Breathing; Freespira; Hyperventilation; Panic disorder; Respiration.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Benchmarking
  • Biofeedback, Psychology / methods*
  • Blood Gas Monitoring, Transcutaneous
  • Breathing Exercises*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Panic Disorder / physiopathology
  • Panic Disorder / therapy*
  • Respiration*
  • Respiratory Rate / physiology*
  • Tidal Volume / physiology*
  • Treatment Outcome