A Review of Cognitive Behavioral Therapy for Panic Disorder in Patients with Chronic Obstructive Pulmonary Disease: The Rationale for Interoceptive Exposure

  • Terri L. BarreraEmail author
  • Kathleen M. Grubbs
  • Mark E. Kunik
  • Ellen J. Teng


Panic disorder commonly co-occurs in patients with chronic obstructive pulmonary disease (COPD), and translational interventions are needed to address the fear of physiological arousal in this population. This paper examines the utility of interoceptive exposures (IE), a key component of cognitive behavioral therapy (CBT) for panic disorder, in patients with comorbid panic and COPD. Our translational review of the literature suggests that IE is supported by both cognitive- and learning-theory perspectives of panic, and that the breathing exercises associated with IE are safe and highly compatible with existing pulmonary rehabilitation exercises for COPD. Unfortunately, few research studies have examined the use of CBT to treat anxiety in COPD patients, and none have included IE. Given the strong theoretical and empirical support for the use of IE, we suggest that mental health providers should consider incorporating IE into CBT interventions for patients with comorbid panic and COPD.


Panic disorder COPD Cognitive behavioral therapy Interoceptive exposure Anxiety 



This research was supported by the Department of Veterans Affairs South Central Mental Illness Research Education and Clinical Center (MIRECC) and the Center for Innovations in Quality, Effectiveness and Safety (#CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, TX. This work was also supported by VA Clinical Sciences Research and Development (CSR&D) Career Development Award (#CADE-MHN/F09) awarded to Ellen J. Teng at the Michael E. DeBakey Veterans Affairs Medical Center. The views expressed reflect those of the authors and not necessarily the Department of Veterans Affairs, US government or Baylor College of Medicine.

Human and Animal Rights and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Conflict of interest

Authors Terri L. Barrera, Kathleen M. Grubbs, Mark E. Kunik and Ellen J. Teng declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Terri L. Barrera
    • 1
    • 2
    • 3
    Email author
  • Kathleen M. Grubbs
    • 4
    • 5
    • 6
  • Mark E. Kunik
    • 1
    • 2
    • 3
  • Ellen J. Teng
    • 1
    • 2
    • 3
  1. 1.Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey Veterans Affairs (VA) Medical CenterHoustonUSA
  2. 2.Veterans Affairs South Central Mental Illness Research, Education, and Clinical CenterHoustonUSA
  3. 3.Menninger Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonUSA
  4. 4.South Central Mental Illness, Research, Education, and Clinical CenterCentral Arkansas Veterans Healthcare SystemNorth Little RockUSA
  5. 5.Center for Mental Health Outcomes ResearchCentral Arkansas Veterans Healthcare SystemNorth Little RockUSA
  6. 6.Department of PsychiatryUniversity of Arkansas for Medical SciencesLittle RockUSA

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