Exploring Heart Rate Variability Changes Following Respiratory Training in Individuals with Panic Disorder

Introduction Studies reported an association between panic disorder (PD) and diminished heart rate variability (HRV) (Zhang et al. J Affect Disord 2020; 15, 267 297-306), potentially heightening their susceptibility to cardiovascular mortality and diminished quality of life. Preliminary research has demonstrated that HRV-biofeedback training can enhance the regulation of autonomic function in both healthy individuals (Schumann et al. Front Neurosci 202;15 691988) and patients with anxiety (Herhaus et al. Psychosom Med 2022; 84, 2 199-209). Objectives We examined the impact of HRV-biofeedback training intervention on autonomic activity modulation among outpatients with PD with or without agoraphobia (AGO). Methods We conducted a retrospective observational pilot study including 10 outpatients (five females and five males; median age = 35.5 years) diagnosed with PD (9 with comorbid AGO and 1 without). The clinician-administered Panic Associated Symptoms Scale (PASS) was used to assess PD and AGO severity. All the included patients underwent a physiological assessment to determine HRV parameters and breathing rate during a 5-minute resting condition at baseline (T0) and follow-up (T1) assessment. Between T0 and T1 assessments, all patients underwent HRV-biofeedback training. Pre-post comparisons were conducted using the Wilcoxon Signed Ranks Test. To evaluate the impact of psychotropic medications, we used the Mann-Whitney U test to compare HRV parameters and disorder severity between patients with and without medications, at T0 and T1. Significance level was set at p<0.05. Results HRV-biofeedback training among individuals with PD with or without AGO fostered notable enhancements in RMSSD (Z = -2.08; p < 0.01), SDNN (Z = -2.5; p = 0.01), and LF (Z = -2.09; p = 0.04) parameters at T1 compared to T0. Furthermore, a significant decrease in heart rate (Z = -2.19; p = 0.03) was shown. These enhancements didn’t seem related to psychopharmacological medications and disorder severity. Conclusions Despite limitations (e.g., small sample, no control group, lack of comorbidity and T1-PD severity assessment, missing inclusion/exclusion criteria, and unaccounted confounding variables affecting HRV), our study suggests that HRV biofeedback training may improve autonomic regulation in PD patients, aligning with existing literature (Herhaus et al. Psychosom Med 2022; 84, 2 199-209). Further research is needed to determine to what extent bio-feedback training can help to reduce panic symptoms and disorder severity. Disclosure of Interest None Declared