Patients reported a new ability to reduce panic symptoms by means of changing their respiration.

“We found that with CART it’s the therapeutic change in carbon dioxide that changes the panic symptoms – and not vice versa,” said Alicia E. Meuret, psychologist and panic disorder expert,  Southern Methodist University in Dallas, TX.

CART stands for Capnometry-Assisted Respiratory Training – a breathing exercise designed to naturally lower carbon dioxide levels. “In our study, cognitive therapy didn’t change respiratory physiology, but CART did effectively reduce hyperventilation. CART was proved an effective and powerful treatment that reduces the panic by means of normalizing respiratory physiology.” (Meuret)

After looking over the study, I’m concerned about the small number of test subjects (41) and the comparison of CART with only one other panic disorder treatment, Cognitive Therapy (CT).

Still, I believe the concept of normalizing CO2 levels is the way to go. High blood levels of CO2 have been shown to create panic attacks. Further, my own experience with clients reporting panic attacks demonstrated to me that deep breathing did not mediate their symptoms – rather, deep breathing tended to exacerbate the condition.

“CART tells us a patient’s CO2 is very low and is causing many of the symptoms feared, but it can also show how to change these symptoms through correct breathing. There has been an assumption that if people worry less about symptoms it will also normalize their physiology, but this study shows that this is not the case,” Meuret said, confirming my experience. “Hyperventilation remains unchanged, which could be a risk factor for relapse down the road. Apart from hyperventilation being a symptom generator, it is an unhealthy biological state associated with negative health outcomes.”

Study source: “Respiratory and cognitive mediators of treatment change in panic disorder: Evidence for intervention specificity,” appeared in the Journal of Consulting and Clinical Psychology. Meuret, who developed CART, is an assistant professor in the Department of Psychology at SMU and co-directs the department’s Stress, Anxiety and Chronic Disease Research Program. Co-authors of the study at SMU were David Rosenfield, associate psychology professor, and psychology graduate students Anke Seidel and Lavanya Bhaskara. Stefan G. Hofmann, psychology professor at Boston University, was also an author on the paper. The Beth & Russell Siegelman Foundation funded the research.