respiratory training vs interoceptive exposure in the treatment of transdiagnostic pathological anxiety

Conditions: Anxiety Disorders; Trauma; Generalized Anxiety Disorder; Panic Disorder; Agoraphobia; Illness Anxiety Disorder; Social Anxiety Disorder; Posttraumatic Stress Disorder; Acute Stress Disorder; Adjustment Disorder With Anxious Mood

Summary: purpose of the research: the primary aim of the proposed study is to conduct a randomized parallel-group 3-arm clinical trial comparing two mechanistically distinct interventions for pathological anxiety - (1) interoceptive exposure (ie) utilizing graduated exposure to somatic cues (respiratory, cardiac, vestibular) with the primary aim of reducing fear responding to the presence of interoceptive perturbations; (2) capnometry-guided respiratory intervention (cgri) aimed at raising end-tidal co2 levels thereby lowering hyperventilation-induced respiratory alkalosis and its associated fear-eliciting somatic reactions; and (3) psycho-education about anxiety and its effects (psyed), which will serve as a credible control comparator.

anxiety sensitivity - the tendency to perceive anxiety as threatening - is a widely recognized risk factor for the development of panic disorder and other anxiety-related psychopathology. interoceptive exposure therapy consisting of repeated exposure to interoceptive cues using respiratory provocation challenges such as hyperventilation and inhalation of various concentrations of co2-enriched air have shown promise in reducing as and are often included in cognitive-behavioral treatments of panic disorder with or without agoraphobia.however, some patients are unwilling to undergo exposure-based treatments, while others who do show only partial response or subsequent relapse. alternatively, low end-tidal co2 (etco2), which is an accompanying feature of hyperventilation, has been associated with a variety of anxiety disorders, including panic disorder and social phobia. more recently, researchers have examined the efficacy of capnometry-guided respiratory intervention (cgri) as a method for increasing etco2 and thereby reducing hyperventilation-induced anxiety/panic symptoms. promising preliminary efficacy studies have shown that cgri results in decreased panic symptom frequency and severity at a rate comparable to that of cognitive therapy. a recent uncontrolled proof-of-concept study showed that cgri led to significant reductions in trauma symptoms in a sample of patients meeting dsm-5 criteria for ptsd. however, neither ie or cgri has been adequately evaluated in the treatment of anxiety disorders other than panic disorder with or without agoraphobia.

Eligibility criteria:
inclusion criteria: 1. clinically elevated anxiety as indicated by an eight or higher on the overall anxiety severity and impairment scale (oasis). 2. meets dsm-5 criteria for one or more of the following anxiety or trauma-related disorders as their "primary" mental disorder: * generalized anxiety disorder * panic disorder * health anxiety * agoraphobia * social anxiety disorder * posttraumatic stress disorder * acute stress disorder * adjustment disorder with primary anxious mood * anxiety disorder not otherwise specified 3. no current use of psychotropic medications or stable on current medications for at least 6 weeks 4. age 18+. 5. able to arrange transportation to our laboratory for study appointments. 6. fluent in english. exclusion criteria: 1. no history of medical conditions that would contraindicate participation in fear-provocation or respiratory challenges, including: * cardiovascular or respiratory disorders * high blood pressure * epilepsy * strokes * seizures * history of fainting * pregnant or lactating 2. not currently receiving other psychological treatment for anxiety. 3. no history of a suicide attempt within the past 6 months. 4. no history of psychosis within the past 6 months. 5. no history of moderate to severe alcohol or substance use disorder (with the exception of nicotine) within the past 3 months. 6. does not endorse covid-19 symptoms during the screening phase.

Keywords: psychoeducation respiratory training interoceptive exposure transdiagnostic intervention