Use of the CGRI breathing technique led to a significant reduction in PTSD and panic disorder symptoms
“Adoption of prescription digital therapeutics such as CGRI hold promise for expanding access and patient choice in the treatment of panic disorder and PTSD." Robert Cuyler et al, study authors
A technique called Capnometry Guided Respiratory Intervention (CGRI) can be effective in treating both post-traumatic stress disorder (PTSD) and panic disorder, research has found.
The study, which has been published in Frontiers, looked at 1,569 people who had been treated with CGRI between September 2017 and September 2021. Patients completed a baseline Panic Disorder Severity Scale (PDSS) or PTSD Checklist for DSM-5 (PCL-5) and submitted self-reporting measurements. After receiving initial support from a health coach, including education about how to use the breathing technique, they were asked to use the technique twice daily for 28 days, with weekly follow-up sessions with the health coach.
CGRI involves using a particular breathing style. A sensor collects data on the individual’s respiratory rate and exhaled carbon dioxide, and then provides real-time feedback via a tablet-based app. Following each session the mean respiratory rates and self-reported symptoms were uploaded from the tablets to a secure server. This enabled the health coach to identify symptom changes or any problems with adherence.
At the end of the study, panic disorder patients showed a mean reduction in PDSS scores of 50.2%, while PTSD patients showed a reduction in PCL-5 scores of 41.4%.
Although they note that one of the limitations of the study was that it not randomised, the authors (Robert Cuyler, Rahul Katdare, Simon Thomas and Michael Telch) say that the study has “several features that increase confidence that the symptom reduction observed in both cohorts was likely due to the CGRI intervention as opposed to extraneous factors.” These include low drop-out rates (10% for panic disorder patients, and 11% for PTSD patients), which reduce the likelihood “that patient attrition was biasing the treatment response rate.”
It is also the case that both PTSD and panic disorder normally “show a chronic clinical course without treatment, thus helping to rule out regression to the mean or spontaneous remission as likely candidates for explaining the observed symptom reduction.”
Compared with standard treatments such as medication and CBT, the benefits of CGRI in the context of the study, the authors say, “include brief duration of treatment, at-home administration, clinically significant symptom reduction, and favorable adherence/dropout rates.”
The researchers concluded that results from this cohort demonstrate “significant rates of symptom reduction and adherence consistent with prior published clinical trials” and provide “encouraging evidence of clinical effectiveness” of the treatment in use outside of a formal research setting. “Adoption of prescription digital therapeutics such as CGRI hold promise for expanding access and patient choice in the treatment of panic disorder and PTSD,” they add.
Traditional methods of treating PTSD and panic disorder, typically talking therapies such as CBT or, in some cases, medication, can be expensive and time-consuming. Patients can wait several months to receive CBT on the NHS. So research showing that certain coached breathing techniques can be helpful in easing symptoms is to be welcomed. We do need to be aware, however, that the authors of the study are all involved with a company that markets the technique in question – although the fact that they used real-world clinical data offers some reassurance. The results seem promising, but more research is necessary before we draw firm conclusions.