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Voluntary Breath Holding in Panic and Generalized Anxiety Disorders

Roth, Walton T. MD; Wilhelm, Frank H. PhD; Trabert, Werner MD

Original Article

Objective Because breath holding causes arterial pCO2 to increase, we used it to test the hypothesis that in panic disorder (PD) a biological suffocation monitor is pathologically sensitive.

Method Nineteen patients with PD, 17 with generalized anxiety disorder (GAD), and 22 normal controls took deep breaths on signal and held them until a release signal was given 30 seconds later. This was repeated 12 times separated by 60-second normal breathing periods.

Results PD patients reported having had in the past more symptoms of shortness of breath when anxious, and more frequent frightening suffocation experiences than the other groups. However, increases in self-rated anxiety between periods of normal breathing and periods of breath holding were similar in all three groups. Skin conductance, blood pressure, and T-wave amplitude reactions to breath holdings were also similar, but heart rate acceleration upon taking a deep breath was greater in GAD patients. Before and after individual breath holdings, end-tidal pCO2 was lower in PD patients than in normal controls; GAD patients were intermediate. Inspiratory flow rate did not differ between groups.

Conclusions Our physiological results provide no direct support for an overly sensitive suffocation alarm system in PD. Lower pCO2 may be due to anxiety causing hyperventilation in patients prone to panic.

From the Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, and Department of Veterans Affairs Medical Center, Palo Alto, California.

Address reprint requests to: Walton T. Roth, MD, VA Palo Alto Health Care System (116F-PAD), 3801 Miranda Ave., Palo Alto, CA 94304-1207. E:mail:

Received for publication November 20, 1997; revision received May 14, 1998.

Copyright © 1998 by American Psychosomatic Society
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