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Are Panic Attacks Really Out Of The Blue? Predictive Biomarkers Of Panic

A lot of panic disorder patients describe their panic attacks as coming out of the blue, with no obvious cause. I came across some interesting research suggesting this is actually a failure to perceive subtle warning signs.

Researchers monitored panic attack sufferers using psychophysiological devices for a period of 24 hours, hoping to observe some spontaneous panic attacks unfold - which indeed some did: 13 of them out of the 43 patients monitored. What they found was that subtle respiratory and autonomic instabilities began appearing almost an hour before the onset of panic. Perhaps even more surprisingly, at the actual onset of panic these physiological changes did not get significantly worse.

Predictive Biomarkers For Panic

What were the measured parameters that showed these instabilities?

  • Skin conductance, or galvanic skin response (GSR) - began to increase well before panic onset. This parameter is driven by the sympathetic nervous system (i.e. the branch of the autonomic nervous system responsible for arousal or "fight or flight").
  • Breathing: panic onset was characterised by over-breathing or hyperventilation - not surprisingly. Hyperventilation was measured using capnometers (i.e. measuring carbon dioxide levels in exhaled air). This measure was unstable in the lead-up period.
  • Heart rate: also increased in a panic attack (presumably also driven by increased sympathetic activation).

Here is the research paper: Do Unexpected Panic Attacks Occur Spontaneously? (Biological Psychiatry, 2011)

Here is a video interview with one of the researchers, psychologist Alicia Meuret:

Implications for Helping Panic Disorder

Should panic patients wear physiological monitoring devices all day so they can track the early warning signs of panic attacks?

In my opinion no - in fact I believe it would be counter-productive. I think it would feed into a mindset of hyper-vigilence and antipatory anxiety - wondering could this be a panic attack coming? This is the very thing that triggers autonomic reactivity.

Breathing Training With Biofeedback

A much better approach is to train stress resilience: the skill-set for easily and quickly recovering when stress does happen.

In fact the same group of researchers, in other research work, demonstrated the validity of using capnometry biofeedback training as therapy for panic disorder - a capnometer being the device used to detect over-breathing by measuring carbon dioxide.

Capnometry biofeedback is one of the main components  of my own Stress Resilience Skills Training Programme.

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