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

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

Author information

Anxiety Disorders Center, The Institute of Living, 200 Retreat Avenue, Hartford, CT, 06106, USA.
Department of Psychiatry, Yale University School of Medicine, 300 George St., New Haven, CT, 06511, USA.
AMITA Health - Alexian Brothers Health System, 600 Alexian Way, Elk Grove Village, IL, 60007, USA.
Kansas City Center for Anxiety Treatment, University of Missouri-Kansas City, 10555 Marty St., Overland Park, KS, 66212, USA.
Department of Psychology, University of California at Berkeley, Tolman Hall, Berkeley, CA, 94720, USA.
Department of Biostatistics, Yale University School of Public Health, 60 College St., New Haven, CT, 06520, USA.


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.


Biofeedback; Breathing; Freespira; Hyperventilation; Panic disorder; Respiration

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