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Further Exploration of Treatment Response in Latinos with Comorbid Asthma and Panic Disorder: A Brief Report of HRV and ETCO2 as Potential Mediators of Treatment Response

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Abstract

Heart rate variability (HRV) and end tidal CO2 (ETCO2) in relation to treatment response have not been studied in Latino populations or in comorbid asthma and panic disorder (PD). An extension of previously published research, the current study explored psychophysiological variables as possible mediators of treatment response. Latino treatment completers (N = 32) in the Bronx with asthma-PD received either Cognitive-Behavioral Psychophysiological Therapy (CBPT) or Music Relaxation Therapy (MRT). CBPT included HRV-biofeedback (HRVB); in-the-moment heart rate data to help an individual learn to influence his/her own heart rate. The sample was primarily female (93.8%) and Puerto Rican (81.25%). Treatment groups did not differ on demographics, except for less education in CBPT. The Panic Disorder Severity Scale (PDSS) and Asthma Control Questionnaire (ACQ) assessed changes in symptoms. HRV and ETCO2 were measured at four of eight therapy sessions. Baseline ETCO2 and changes in HRV from first to last of psychophysiology sessions were investigated as mediators of change on ACQ and PDSS. Mixed model analyses indicated in the CPBT group, changes in both asthma control and PD severity were not mediated by changes in HRV. In the CBPT and MRT groups combined, changes in PD severity were not mediated by baseline ETCO2. These findings may be due to the brevity of HRVB in CBPT, multiple treatment components, ETCO2 not directly targeted, and/or unique physiological pathways in Latinos with asthma-PD.

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Reproduced with permission from Feldman et al. (2016)

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References

  • Boudreau, M., Lavoie, K. L., Cartier, A., Trutshnigg, B., Morizio, A., Lemière, C., et al. (2015). Do asthma patients with panic disorder really have worse asthma? A comparison of physiological and psychological responses to a methacholine challenge. Respiratory Medicine,109(10), 1250–1256.

    Article  PubMed  Google Scholar 

  • Choi, J.-B., Hong, S., Nelesen, R., Bardwell, W. A., Natarajan, L., Schubert, C., et al. (2006). Age and ethnicity differences in short-term heart-rate variability. Psychosomatic Medicine,68(3), 421–426.

    Article  PubMed  Google Scholar 

  • Chuang, C.-Y., Han, W.-R., Li, P.-C., & Young, S.-T. (2010). Effects of music therapy on subjective sensations and heart rate variability in treated cancer survivors: A pilot study. Complementary Therapies in Medicine,18(5), 224–226.

    Article  PubMed  Google Scholar 

  • Dager, S. R., Strauss, W. L., Marro, K. I., Richards, T. L., Metzger, G. D., & Artru, A. A. (1995). Proton magnetic resonance spectroscopy investigation of hyperventilation in subjects with panic disorder and comparison subjects. American Journal of Psychiatry,152(5), 666–672.

    Article  PubMed  Google Scholar 

  • Davies, C. D., & Craske, M. G. (2014). Low baseline pCO2 predicts poorer outcome from behavioral treatment: Evidence from a mixed anxiety disorders sample. Psychiatry Research,219(2), 311–315. https://doi.org/10.1016/j.psychres.2014.06.003.

    Article  PubMed  Google Scholar 

  • Dekker, J. M., Crow, R. S., Folsom, A. R., Hannan, P. J., Liao, D., Swenne, C. A., et al. (2000). Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes. The ARIC Study. Circulation,102(11), 1239–1244.

    Article  PubMed  Google Scholar 

  • Feldman, J. M., Matte, L., Interian, A., Lehrer, P. M., Lu, S.-E., Scheckner, B., et al. (2016). Psychological treatment of comorbid asthma and panic disorder in Latino adults: Results from a randomized controlled trial. Behaviour Research and Therapy,87, 142–154. https://doi.org/10.1016/j.brat.2016.09.007.

    Article  PubMed  PubMed Central  Google Scholar 

  • First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. (1995). Structured clinical interview for DSM-IV axis I disorders-patient edition (SCID-I/P, Version 2.0). New York: Biometrics Research Department, New York State Psychiatric Institute, 722.

  • Friedman, B. H., & Thayer, J. F. (1998). Autonomic balance revisited: Panic anxiety and heart rate variability. Journal of Psychosomatic Research,44(1), 133–151.

    Article  PubMed  Google Scholar 

  • Garakani, A., Martinez, J. M., Aaronson, C. J., Voustianiouk, A., Kaufmann, H., & Gorman, J. M. (2009). Effect of medication and psychotherapy on heart rate variability in panic disorder. Depression and Anxiety,26(3), 251–258.

    Article  PubMed  Google Scholar 

  • Garrard, C. S., Seidler, A., McKibben, A., McAlpine, L. E., & Gordon, D. (1992). Spectral analysis of heart rate variability in bronchial asthma. Clinical Autonomic Research,2(2), 105–111.

    Article  PubMed  Google Scholar 

  • Goodwin, R. D., Pine, D. S., & Hoven, C. W. (2003). Asthma and panic attacks among youth in the community. Journal of Asthma,40(2), 139–145.

    Article  PubMed  Google Scholar 

  • Gorman, J. M., Fyer, M. R., Goetz, R., Askanazi, J., Liebowitz, M. R., Fyer, A. J., et al. (1988). Ventilatory physiology of patients with panic disorder. Archives of General Psychiatry,45(1), 31–39.

    Article  PubMed  Google Scholar 

  • Hasler, G., Gergen, P. J., Kleinbaum, D. G., Ajdacic, V., Gamma, A., Eich, D., et al. (2005). Asthma and panic in young adults: A 20-year prospective community study. American Journal of Respiratory and Critical Care Medicine,171(11), 1224–1230.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ibrahim, J. G., & Molenberghs, G. (2009). Missing data methods in longitudinal studies: A review. Test,18(1), 1–43.

    Article  PubMed  Google Scholar 

  • Juniper, E. F., Obyrne, P. M., Guyatt, G. H., Ferrie, P. J., & King, D. R. (1999). Development and validation of a questionnaire to measure asthma control. European Respiratory Journal,14(4), 902–907. https://doi.org/10.1034/j.1399-3003.1999.14d29.x.

    Article  PubMed  Google Scholar 

  • Karavidas, M. K., Lehrer, P. M., Vaschillo, E., Vaschillo, B., Marin, H., Buyske, S., et al. (2007). Preliminary results of an open label study of heart rate variability biofeedback for the treatment of major depression. Applied Psychophysiology and Biofeedback,32(1), 19–30.

    Article  PubMed  Google Scholar 

  • Kazuma, N., Otsuka, K., Matsuoka, I., & Murata, M. (1997). Heart rate variability during 24 hours in asthmatic children. Chronobiology International,14(6), 597–606.

    Article  PubMed  Google Scholar 

  • Kleiger, R. E., Miller, J. P., Bigger, J. T., & Moss, A. J. (1987). Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. The American journal of cardiology,59(4), 256–262.

    Article  PubMed  Google Scholar 

  • Klein, E., Cnaani, E., Harel, T., Braun, S., & Ben-Haim, S. A. (1995). Altered heart rate variability in panic disorder patients. Biological Psychiatry,37(1), 18–24.

    Article  PubMed  Google Scholar 

  • La Rovere, M. T., Pinna, G. D., Maestri, R., Mortara, A., Capomolla, S., Febo, O., et al. (2003). Short-term heart rate variability strongly predicts sudden cardiac death in chronic heart failure patients. Circulation,107(4), 565–570.

    Article  PubMed  Google Scholar 

  • Lehrer, P., Vaschillo, E., Lu, S.-E., Eckberg, D., Vaschillo, B., Scardella, A., et al. (2006). Heart rate variability biofeedback: Effects of age on heart rate variability, baroreflex gain, and asthma. Chest Journal,129(2), 278–284.

    Article  Google Scholar 

  • Lehrer, P. M., Vaschillo, E., & Vaschillo, B. (2000). Resonant frequency biofeedback training to increase cardiac variability: Rationale and manual for training. Applied Psychophysiology and Biofeedback,25(3), 177–191.

    Article  PubMed  Google Scholar 

  • Lehrer, P. M., Vaschillo, E., Vaschillo, B., Lu, S.-E., Scardella, A., Siddique, M., et al. (2004). Biofeedback treatment for asthma. Chest Journal,126(2), 352–361.

    Article  Google Scholar 

  • Liao, D., Barnes, R. W., Chambless, L. E., Simpson, R. J., Sorlie, P., Heiss, G., et al. (1995). Age, race, and sex differences in autonomic cardiac function measured by spectral analysis of heart rate variability: The ARIC study. The American Journal of Cardiology,76(12), 906–912.

    Article  PubMed  Google Scholar 

  • Maddock, R. J., & Carter, C. S. (1991). Hyperventilation-induced panic attacks in panic disorder with agoraphobia. Biological Psychiatry,29(9), 843–854. https://doi.org/10.1016/0006-3223(91)90051-M.

    Article  PubMed  Google Scholar 

  • Meuret, A. E. (2007). Targeting pCO(2) in asthma: Pilot evaluation of a capnometry-assisted breathing training. Applied Psychophysiology and Biofeedback,32(2), 99–109. https://doi.org/10.1007/s10484-007-9036-8.

    Article  PubMed  Google Scholar 

  • Meuret, A. E., Rosenfield, D., Hofmann, S. G., Suvak, M. K., & Roth, W. T. (2009). Changes in respiration mediate changes in fear of bodily sensations in panic disorder. Journal of Psychiatric Research,43(6), 634–641.

    Article  PubMed  Google Scholar 

  • Meuret, A. E., Rosenfield, D., Seidel, A., Bhaskara, L., & Hofmann, S. G. (2010). Respiratory and cognitive mediators of treatment change in panic disorder: Evidence for intervention specificity. Journal of Consulting and Clinical Psychology,78(5), 691–704. https://doi.org/10.1037/a0019552.

    Article  PubMed  PubMed Central  Google Scholar 

  • Meuret, A. E., Wilhelm, F. H., & Roth, W. T. (2001). Respiratory biofeedback-assisted therapy in panic disorder. Behavior Modification,25(4), 584–605.

    Article  PubMed  Google Scholar 

  • Musselman, D. L., Evans, D. L., & Nemeroff, C. B. (1998). The relationship of depression to cardiovascular disease: Epidemiology, biology, and treatment. Archives of General Psychiatry,55(7), 580–592.

    Article  PubMed  Google Scholar 

  • Nascimento, I., Nardi, A. E., Valença, A. M., Lopes, F. L., Mezzasalma, M. A., Nascentes, R., et al. (2002). Psychiatric disorders in asthmatic outpatients. Psychiatry Research,110(1), 73–80.

    Article  PubMed  Google Scholar 

  • National Heart Lung and Blood Institute. (1997). Expert panel report 2: Guidelines for the diagnosis and management of asthma. DIANE Publishing.

  • National Heart Lung and Blood Institute. (2013). Hispanic Community Health Study: Study of Latinos Data Book. NIH Publication No. 13-7951.

  • Papp, L. A., Martinez, J. M., Klein, D. F., Coplan, J. D., Norman, R. G., Cole, R., et al. (1997). Respiratory psychophysiology of panic disorder: Three respiratory challenges in 98 subjects. American Journal of Psychiatry,154(11), 1557–1565.

    PubMed  Google Scholar 

  • Raglio, A., Oasi, O., Gianotti, M., Manzoni, V., Bolis, S., Ubezio, C., et al. (2010). Effects of music therapy on psychological symptoms and heart rate variability in patients with dementia. A pilot study. Current Aging Science,3(3), 242–246.

    Article  PubMed  Google Scholar 

  • Ritz, T., Rosenfield, D., Steele, A. M., Millard, M. W., & Meuret, A. E. (2014). Controlling asthma by training of Capnometry-Assisted Hypoventilation (CATCH) vs slow breathing: A randomized controlled trial. Chest Journal,146(5), 1237–1247.

    Article  Google Scholar 

  • Shear, M. K., Rucci, P., Williams, J., Frank, E., Grochocinski, V., Vander Bilt, J., et al. (2001). Reliability and validity of the Panic Disorder Severity Scale: Replication and extension. Journal of Psychiatric Research,35(5), 293–296. https://doi.org/10.1016/S0022-3956(01)00028-0.

    Article  PubMed  Google Scholar 

  • Siepmann, M., Aykac, V., Unterdörfer, J., Petrowski, K., & Mueck-Weymann, M. (2008). A pilot study on the effects of heart rate variability biofeedback in patients with depression and in healthy subjects. Applied Psychophysiology and Biofeedback,33(4), 195–201.

    Article  PubMed  Google Scholar 

  • Stapelberg, N. J., Hamilton-Craig, I., Neumann, D. L., Shum, D. H., & McConnell, H. (2012). Mind and heart: Heart rate variability in major depressive disorder and coronary heart disease: A review and recommendations. Australian and New Zealand Journal of Psychiatry,46(10), 946–957.

    Article  PubMed  Google Scholar 

  • Thayer, J. F., Hansen, A. L., Saus-Rose, E., & Johnsen, B. H. (2009). Heart rate variability, prefrontal neural function, and cognitive performance: The neurovisceral integration perspective on self-regulation, adaptation, and health. Annals of Behavioral Medicine,37(2), 141–153.

    Article  PubMed  Google Scholar 

  • Tsuji, H., Larson, M. G., Venditti, F. J., Manders, E. S., Evans, J. C., Feldman, C. L., et al. (1996). Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. Circulation,94(11), 2850–2855.

    Article  PubMed  Google Scholar 

  • Van den Elshout, F., Van Herwaarden, C., & Folgering, H. (1991). Effects of hypercapnia and hypocapnia on respiratory resistance in normal and asthmatic subjects. Thorax,46(1), 28–32.

    Article  PubMed  PubMed Central  Google Scholar 

  • Yeragani, V. K., Pohl, R., Berger, R., Balon, R., Ramesh, C., Glitz, D., et al. (1993). Decreased heart rate variability in panic disorder patients: A study of power-spectral analysis of heart rate. Psychiatry Research,46(1), 89–103.

    Article  PubMed  Google Scholar 

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Acknowledgements

Funding for this study was provided by the National Institute of Mental Health: 1R34MH087679, PI: Jonathan M. Feldman, Ph.D. Spanish translation of measures was funded by the Einstein-Montefiore ICTR 5UL-1TR001073-02. Special thanks to Dr. Melissa D. McKee, Ms. Claudia Lechuga, and the New York City Research and Improvement Networking Group for their assistance with recruitment of participants. Special thanks also for the cooperation from the New York City Health and Hospitals Corporation, Jacobi Medical Center, and Montefiore Medical Center.

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Authors and Affiliations

  1. Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Rousso Building, Bronx, NY, 10461, USA

    Krista L. Nelson, Tanya Oken & Jonathan M. Feldman

  2. Rutgers - School of Public Health, 683 Hoes Lane West, Piscataway, NJ, 08854, USA

    Shou-En Lu

  3. Department of Psychiatry, Rutgers – Robert Wood Johnson Medical School, 671 Hoes Lane, Piscataway, NJ, 08854, USA

    Paul M. Lehrer

  4. Department of Pediatrics (Academic General Pediatrics), Albert Einstein College of Medicine/Children’s Hospital at Montefiore, 1300 Morris Park Avenue, Bronx, NY, 10461, USA

    Jonathan M. Feldman

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  1. Krista L. Nelson
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Correspondence to Jonathan M. Feldman.

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This study has been approved by the appropriate ethics committee and all procedures were performed in accordance with the ethical standards of the institution. All procedures performed were also in accordance with the ethical standards enumerated in the 1964 Declaration of Helsinki, as well as its later amendments or comparable ethical standards. All participants gave their informed consent prior to their inclusion in the current research.

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Nelson, K.L., Lu, SE., Oken, T. et al. Further Exploration of Treatment Response in Latinos with Comorbid Asthma and Panic Disorder: A Brief Report of HRV and ETCO2 as Potential Mediators of Treatment Response. Appl Psychophysiol Biofeedback 45, 67–74 (2020). https://doi.org/10.1007/s10484-020-09454-3

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