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Wall Street Journal: For better talk therapy, try taking a nap

Doctors are finding creative ways to make cognitive behavioral therapy more effective

The Wall Street Journal has covered the latest research of SMU clinical psychologist Alicia Meuret, quoting her as an expert source.

The article, “For better talk therapy, try taking a nap,” published Nov. 28.

Meuret is director of the Anxiety and Depression Research Center at SMU, with expertise in discussing the differences between fear and anxiety and when each is helpful and adaptive and when they are harmful and interfere with our lives.

An associate professor in the Clinical Psychology Division at the SMU Department of Psychology, Meuret received her Ph.D. in Clinical Psychology from the University of Hamburg based on her doctoral work conducted at the Department of Psychiatry and Behavioral Sciences at Stanford University. She completed postdoctoral fellowships at the Center for Anxiety and Related Disorders at Boston University and the Affective Neuroscience Laboratory in the Department of Psychology at Harvard University.

Her research program focuses on novel treatment approaches for anxiety and mood disorders, biomarkers in anxiety disorders and chronic disease, fear extinction mechanisms of exposure therapy, and mediators and moderators in individuals with affective dysregulations, including non-suicidal self-injury.

The article “For better talk therapy, try taking a nap,” cites new findings from Meuret’s research, which found patients undergoing exposure therapy for anxiety fared better when sessions were held in the morning when levels of the helpful natural hormone cortisone are higher in the brain.

Read the full story.

EXCERPT:

By Andrea Petersen
Wall Street Journal

New tweaks are improving the age-old practice of talk therapy.

Doing therapy in the morning, taking a nap afterward or adding a medication that enhances learning are just a few of the methods scientists are discovering that can make cognitive behavioral therapy work better.

CBT, which involves changing dysfunctional patterns of thoughts and behaviors, is one of the most well-researched and effective treatments for a range of mental health issues, including anxiety disorders, depression and eating disorders.

But about a quarter to half of people with depression and anxiety don’t get significant relief after a course of CBT, which usually consists of about 12 to 15 weekly sessions. Some patients find the treatment time-consuming and difficult. Anywhere from 15% to 30% of people who begin it don’t finish, says David H. Barlow, founder of the Center for Anxiety and Related Disorders at Boston University. “There’s still plenty of room for improvement,” he says.

A study published in September in the journal Psychoneuroendocrinology that involved 24 patients with anxiety disorders found that therapy appointments earlier in the day were more effective than those later in the day.

In the study, subjects—who all had panic disorder with agoraphobia (fear of situations where escape may be difficult)—were treated with exposure therapy, a common component of CBT: They repeatedly confronted situations they feared, such as being in elevators or crowds. Subjects with sessions early in the day reported less severe anxiety symptoms at their next session than those who had sessions later in the day.

The researchers found that higher levels of the stress hormone cortisol that naturally occur in the morning were responsible for at least part of the benefit of the earlier sessions. “Acute boosts of cortisol can actually facilitate learning,” says Alicia E. Meuret, associate professor of psychology at Southern Methodist University and lead author of the study.

Read the full story.

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Psychotherapy sessions are best in the morning when levels of helpful hormone are high

New study found patients with anxiety, phobias and fears showed greater improvement from therapy that was scheduled in the morning, when levels of cortisol — a naturally occurring hormone — test higher.

Patients make more progress toward overcoming anxiety, fears and phobias when their therapy sessions are scheduled in the morning, new research suggests.

The study found that morning sessions helped psychotherapy patients overcome their panic and anxiety and phobic avoidance better, in part, because levels of cortisol — a naturally occurring hormone — are at their highest then, said clinical psychologist Alicia E. Meuret, Southern Methodist University, Dallas.

“The hormone cortisol is thought to facilitate fear extinction in certain therapeutic situations,” said Meuret, lead author on the research. “Drugs to enhance fear extinction are being investigated, but they can be difficult to administer and have yielded mixed results. The findings of our study promote taking advantage of two simple and naturally occurring agents – our own cortisol and time of day.”

The findings were reported in the article “Timing matters: Endogenous cortisol mediates benefits from early-day psychotherapy” in the journal Psychoneuroendocrinology.

Co-authors from the SMU Department of Psychology are David Rosenfield, Lavanya Bhaskara and Thomas Ritz. Co-authors from the Department of Psychiatry at the University of Michigan are Richard Auchus, Israel Liberzon, and James L. Abelson.

The study taps into research that anxiety and phobias are best treated by learning corrective information. Patients with anxiety and phobic disorders will overestimate the threat that a sensation or situation can cause. But by direct exposure, a patient learns that the likelihood of an expected catastrophe is very low.

“For example, a patient may think that standing in an elevator could cause him or her to lose control or faint, suffocate, or may create physical symptoms that would be intolerable,” Meuret said. “By having them stand in an elevator for a prolonged time, the patient learns that their feared outcome does not occur, despite high levels of anxiety. We call this corrective learning.”

However, since not all patients benefit equally from exposure therapy, researchers seek to identify ways to enhance corrective learning. To date, no simple way to augment fear extinction has been established.

The hormone cortisol is thought to help the extinction of fear. It appears to suppress the fear memory established by earlier distressing encounters while at the same time helping a patient better absorb and remember the new corrective information.

“In a prior study, we have shown that higher levels of cortisol during and in anticipation of exposure facilitate corrective learning,” said Meuret, an associate professor in the SMU Psychology Department and director of the SMU Anxiety and Depression Research Center in the Clinical Psychology Division of the department. “We also know that cortisol is higher early in the day. But we did not know whether cortisol would act as a mediator between time of day and therapeutic gains. This is what our study investigated.”

Exposure therapy in general resulted in significant improvements
Participants in the study were 24 people diagnosed with panic disorder and agoraphobia, which is a fear of public places where a person feels panicked, trapped or helpless.

For the study, participants underwent a standard psychotherapeutic treatment of “exposure therapy,” in which patients are exposed to situations that can typically induce their panic or fear with the goal that repeated exposure can help diminish a disabling fear response over time.

Patients received weekly sessions over three weeks, each lasting, on average, 40 minutes. Exposure situations included tall buildings, highways and overpasses, enclosed places such as elevators, supermarkets, movie theaters, and public transportation such as subways and intercity trains and boats. In addition, levels of cortisol were measured at various times during each exposure session by swabbing inside the mouth for saliva.

In the session following exposure, the researchers measured patients’ appraisals of the threats, their avoidance behavior, how much control they perceived themselves as having, and the severity of their panic symptoms.

Assessing the results from those measurements, the researchers found the exposure therapy in general resulted in significant improvements in all measures over all time periods.

Biggest gains after sessions that started earlier in the day
However, patients made the biggest gains in overcoming their fears after the sessions that started earlier in the day. At the next session, patients reported less severe symptoms for threat misappraisal, avoidance behaviors and panic symptom severity. They also perceived greater control over their panic symptoms.

“Notably, higher cortisol was related to greater reductions in threat appraisal, perceived control and panic symptom severity at the next session,” Meuret said, “and that was the case over-and-above the effects of time-of-day, with large effect sizes.”

That finding suggests that cortisol accounts for some of the therapeutic effects associated with time-of-day, she said.

Because cortisol levels are generally higher in the morning, the authors speculate that higher cortisol levels may aid extinction learning, and contribute to enhanced early-day benefits of exposure sessions through such a mechanism.

However, Meuret cautioned that the precise mechanism by which cortisol enhances the effectiveness of morning exposure sessions remains unclear and can’t be directly addressed from the data in this study. The sample size of the study was small and findings need to be confirmed independently in larger studies, she said.

Meuret and her team suspect additional mechanisms are at play to explain the time-of-day effect. Other factors could include memory and learning and the body’s natural circadian rhythm, quantity and quality of sleep, attention control, and interactions between those factors and others. — Margaret Allen, SMU

Follow SMU Research on Twitter, @smuresearch.

For more SMU research see www.smuresearch.com.

SMU is a nationally ranked private university in Dallas founded 100 years ago. Today, SMU enrolls nearly 11,000 students who benefit from the academic opportunities and international reach of seven degree-granting schools. For more information, www.smu.edu.

SMU has an uplink facility located on campus for live TV, radio, or online interviews. To speak with an SMU expert or book an SMU guest in the studio, call SMU News & Communications at 214-768-7650.

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Asthma patients reduce symptoms, improve lung function with shallow breaths, more CO2

New study finds taking deep breaths doesn’t work; sufferers pairing biofeedback with shallow breaths increased carbon dioxide and improved long-term lung health

Asthma patients taught to habitually resist the urge to take deep breaths when experiencing symptoms were rewarded with fewer symptoms and healthier lung function, according to a new study from Southern Methodist University, Dallas.

The findings are from a large clinical trial funded with a grant from the National Institutes of Health’s National Heart, Lung, and Blood Institute.

The results suggest asthma patients using behavioral therapy in conjunction with their daily asthma medicine can improve their lung health over the long-term, said principal investigators Thomas Ritz and Alicia E. Meuret, both SMU clinical psychologists.

Also, sufferers may potentially reduce their dependence on emergency medication, such as rescue inhalers, the researchers said.

SMU behavioral psychologist Dr. Alicia Meuret helps a patient learn shallow breathing with biofeedback to relieve symptoms of air hunger. (Photo: SMU)
SMU clinical psychologist Dr. Alicia Meuret helps a patient learn shallow breathing with biofeedback to relieve symptoms of air hunger. (Photo: SMU)

Asthma can be a life-threatening disease if not managed properly, according to the American Lung Association. Nearly 26 million Americans have asthma, says ALA.

One of the most common chronic disorders in childhood, asthma is the third leading cause of hospitalization among children under 15, ALA says.

Asthma attacks typically provoke sufferers to gulp air and take deep breaths to relieve the frightening fear of asphyxiation, said Ritz and Meuret. In addition, asthma sufferers tend to breathe too much even when not experiencing symptoms.

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But Ritz, Meuret and their co-authors found with their research that deep breathing is exactly the wrong thing to do.

For their study, one group of asthma patients used biofeedback to monitor their breathing for reassurance they were getting sufficient oxygen. The patients practiced shallower, shorter breaths to increase their intake of carbon dioxide, CO2. A second group also practiced slower breathing, but without biofeedback.

“This study goes to the heart of hyperventilation — which is deep, rapid breathing that causes a drop in CO2 gas in the blood. That makes a person feel dizzy and short of breath,” Ritz said. “Patients in our study increased CO2 and reduced their symptoms. And over a six-month period we saw in the biofeedback group an actual improvement in the physiology of their lungs.”

The researchers reported their findings in the pulmonology medical journal Chest, “Controlling asthma by training of capnometry-assisted hypoventilation vs. slow breathing.” Ritz is a professor and Mueret an associate professor in the Department of Psychology in SMU’s Dedman College.

Shallow breathing method is counterintuitive
“When people hyperventilate, there is something very strange happening,” Meuret said. “In essence they are taking in too much air. But the sensation that they get is shortness of breath, choking, air hunger, as if they’re not getting enough air. It’s almost like a biological system error.”

Onlookers commonly give the advice, “Take a deep breath.” But that’s just the opposite of what a struggling breather should do.

“They don’t need any more oxygen,” Meuret said. “But consciously or not, people start to take deeper breaths — and that makes the symptoms worse.”

Among the study’s 120 patients who used the brief, four-week biofeedback therapy to boost their CO2, the researchers found that of 21 clinical indices of pathology more than 80 percent resulted in significant reductions. The researchers saw improvement in asthma symptoms and control, better lung function, reduced oversensitivity of the airways and less use of reliever medication, as well as improvement in physiology and the pathology of the airways.

Biofeedback method tested against tough scientific control group
The biological-behavioral treatment method, called Capnometry-Assisted Breathing Training, or CART for short, was developed by Meuret. Previous randomized controlled studies by Meuret found CART reduced symptoms of panic and hyperventilation in patients with panic and anxiety.

The handheld capnometer, equipped with a digital readout, enables patients via biofeedback to track changes in their CO2 when they alter their breathing during breathing training exercises and instruction sessions. Capnometers are medical devices that can only be purchased by a health care provider.

For the current SMU study, CART patients were compared to a randomized control group that also received a breathing treatment — specifically, slower breathing, or SLOW for short.

Patients in the SLOW group used the CART device also for their home exercises to validate they were breathing slower. The only difference between the CART and SLOW groups was that CART patients received biofeedback about their CO2.

“We tested CART against the toughest scientific control we could devise — another breathing treatment, where patients receive the same amount of attention from their therapist, use equipment to help them alter their breathing, are primed to pay attention to their own asthma management, and receive encouragement to take their medicine more regularly,” Ritz said.

CART and SLOW patients both improved, but CART benefits were long-lasting
Patients in the study were from the Dallas-Fort Worth area, all of them medically diagnosed with asthma. Each patient’s asthma diagnosis was independently validated at Baylor University Medical Center at Dallas by a methacholine airways stress test, a stringent diagnostic procedure to confirm patients met the criteria for asthma.

After four weeks of CART and SLOW training, asthma symptoms for both groups had improved, even when controlling for any change in medication intake.

However at follow up six months later, asthma symptoms for the SLOW control group had returned to higher levels.

“The follow-up period is often viewed as the moment of truth of how effective a treatment is,” said Meuret. “Once a patient doesn’t have to come to treatment, does the treatment continue to be beneficial? After four weeks, both treatments were beneficial, but CART was superior — and showed even greater improvements beyond that.”

CART patients also became less distressed about the methacholine test, indicating higher distress tolerance to their symptoms, Ritz said.

In addition, during treatment, the airways of CART patients widened during treatment in the lab, according to measurements taken by a forced oscillation technique. That was a positive development that allowed patients to breathe easier. Airways in the SLOW group actually narrowed a bit, said Ritz. Nevertheless, SLOW resulted in significant improvement also.

“The long-term goal of the CART research is to test whether we can achieve the same improvements with occasional intervals of capnometer feedback training, or ideally test whether shallow breathing in itself will achieve the same stable increases in CO2,” said the researchers.

CART not a relaxation technique
CART is not relaxation training. Quite the opposite.

“It’s actually very, very, very unrelaxing when patients start,” Meuret said.

For patients with low CO2 in particular, the process of breathing slow and shallow to increase the CO2 level — even just slightly — tends to trigger extreme air hunger.

“Only by reassuring themselves that the symptoms are caused by low CO2 and not low oxygen, they can keep on going,” Meuret said. “And that’s even more difficult for asthmatics than anxious patients who have a normal lung function.”

Patients initially want to take a deep breath, she said. “But I reassure them not to, telling them to ‘Look at the CART device, look at their oxygen, it’s at 100 percent, it can’t get any higher.’”

CART therapy can improve quality of life, reduce health dangers
“The goal is to reduce the need of the emergency medication,” Ritz said. “It’s a quality of life issue.”

Patients with asthma symptoms miss out on sports, limit their physical activity, or are kept out of school P.E. and other activities. They can also become depressed and anxious, and get over-sensitive to sensations.

“The more you can reduce these symptoms the more the person can take part in daily life like a normal person,” Ritz said.

Physiologically, symptoms are also an indicator the asthma patient may have more inflammation and constriction.

While there’s always the risk an attack may be fatal, Ritz said, lesser outcomes are serious also. It’s recommended to intervene in asthma early, ideally during childhood, because the airways become reshaped.

“The longer they’re inflamed, the thicker the tissue of the airways get and the narrower the airways and the less they can relax,” he said.

Other co-authors on the study were SMU psychologist David Rosenfield, graduate student Ashton M. Steele, and physician Mark W. Millard, Baylor University Medical Center Dallas. — Margaret Allen

Follow SMUResearch.com on twitter at @smuresearch.

SMU is a nationally ranked private university in Dallas founded 100 years ago. Today, SMU enrolls nearly 11,000 students who benefit from the academic opportunities and international reach of seven degree-granting schools. For more information see www.smu.edu.

SMU has an uplink facility located on campus for live TV, radio, or online interviews. To speak with an SMU expert or book an SMU guest in the studio, call SMU News & Communications at 214-768-7650.

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Toronto Star: Parents have a key role to play in teaching healthy relationship skills

A research study by Ernest Jouriles in collaboration with others in the SMU Department of Psychology is cited in a Nov. 5 article in the Toronto Star.

Journalist Ann Douglas elaborates on the study in her article about the way parents make a difference when it comes to encouraging their children to make healthy relationship choices.

The study, “Teens’ experiences of harsh parenting and exposure to severe intimate partner violence: Adding insult to injury in predicting teen dating violence,” was published in April in the journal “Psychology of Violence.”

Co-authors with Jouriles on the study were Victoria Mueller, David Rosenfield, Renee McDonald and Catherine Dodson.

Read the full article.

EXCERPT:

By Ann Douglas
Toronto Star

Parents can make a difference when it comes to encouraging their children to make healthy relationship choices down the road.

These skills don’t develop automatically — nor can you expect to cover everything your child needs to know in a one-time “facts of relationships” conversation.

You’ll want to start the conversation about respectful and empathetic relationships during the preschool years, or even earlier, and to carry on that conversation throughout the teen years and beyond, says Lynn Zimmer, executive director of YWCA Peterborough, Victoria, and Haliburton, a non-profit organization that operates a secure emergency shelter for women and children fleeing abuse.

She encourages parents to consider the following question: “What values can you transmit to your children so that they are respectful and resilient — not completely compliant, and yet not doing harm to others?”

Children learn more from our actions than from our words.

“We have to think about what relationship models we are providing for our children — to consider what they are seeing at home,” notes writer and speaker Michael Kaufman, co-founder of the White Ribbon Campaign.

Research indicates that harsh parenting — parenting that is physically or verbally abusive — affects children’s perceptions of what constitutes a loving relationship.

A study conducted at Southern Methodist University and published in Psychology of Violence this past April, noted that teenagers who have been traumatized by harsh parenting and exposure to violence in the home may be “primed to respond aggressively to negative behavior from a romantic partner, or even to ambiguous behavior that they erroneously interpret as hostile or threatening.” In other words, trauma may interfere with the brain’s ability to make sense of and to cope with conflict in a relationship.

Read the full article.

Follow SMU Research on Twitter, @smuresearch.

For more SMU research see www.smuresearch.com.

SMU is a nationally ranked private university in Dallas founded 100 years ago. Today, SMU enrolls nearly 11,000 students who benefit from the academic opportunities and international reach of seven degree-granting schools. For more information, www.smu.edu.

SMU has an uplink facility located on campus for live TV, radio, or online interviews. To speak with an SMU expert or book an SMU guest in the studio, call SMU News & Communications at 214-768-7650.

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Baylor Innovations: Don’t Panic, New Research Shows That Panic Attacks Are Not As Spontaneous As Once Thought

Baylor Innovations, the quarterly magazine of Baylor Health Care System, featured the groundbreaking panic attack research of SMU psychologists Dr. Alicia E. Meuret, Dr. David Rosenfield and Dr. Thomas Ritz.

The Spring 2012 article by health and science writer Mark Cantrell, titled “Don’t Panic: New Research Shows That Panic Attacks Are Not As Spontaneous As Once Thought” details the startling findings of Meuret’s newest published study showing significant physiological instability in advance of so-called out-of-the-blue panic attacks.

Read the full story.

EXCERPT:

By Mark Cantrell
Baylor Innovations

YOUR HANDS ARE SHAKING. YOUR KNEES FEEL WEAK. You’re sweating, your heart is pounding like a jackhammer and you feel you can’t catch your breath. You’re having a panic attack, and it seems to have struck without warning.

But did it? A new study conducted at Southern Methodist University in Dallas suggests that panic attacks are actually telegraphed ahead of time by certain physiological changes.

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defines a panic attack as a discrete period of intense fear and discomfort in which symptoms such as a racing heart, shortness of breath or dizziness develop suddenly and reach a peak in about 10 minutes.

Those experiencing an attack may believe they’re having a heart attack or stroke. But one of the most distressing things about panic attacks is that they often seem to have no actual cause.

Out of Nowhere?
“Unexpected attacks – as compared to those triggered by certain situations such as flying, being in a closed space or speaking in public – are thought to occur spontaneously, in absence of internal signals or situational triggers,” explains Alicia Meuret, Ph.D., an associate professor at Southern Methodist University and chief investigator of the study.

“The literature on how the body reacts when patients who are prone to them have an unexpected attack is very limited, due to the unexpectedness of the phenomenon. To date we do not know what triggers these attacks, but it is likely that the causes are multifactorial.”

For the study, Dr. Meuret enlisted 43 people with a history of panic attacks to wear portable monitors that captured changes in respiration, heart rate and other bodily functions.

The device was worn in a waist pack, with sensors attached at various points. Elastic bands around the chest and abdomen measured breathing rate, depth and variability.

Electrodes kept track of patients’ cardiac and sweat gland activity, while accelerometers measured body movement. Participants were instructed to press a “panic button” at the moment they felt the onset of an attack, and to write down the symptoms they were feeling at the time.

Read the full story.

Follow SMU Research on Twitter, @smuresearch.

For more SMU research see www.smuresearch.com.

SMU is a nationally ranked private university in Dallas founded 100 years ago. Today, SMU enrolls nearly 11,000 students who benefit from the academic opportunities and international reach of seven degree-granting schools. For more information, www.smu.edu.

SMU has an uplink facility located on campus for live TV, radio, or online interviews. To speak with an SMU expert or book an SMU guest in the studio, call SMU News & Communications at 214-768-7650.

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GoodTherapy.org: Children Need Direct Answers after Interparent Violence

The research of SMU psychologists Renee McDonald, Ernest Jouriles and David Rosenfield was featured in an article on the web site GoodTherapy.org.

McDonald, lead author on the research and a professor of psychology, researches specific child adjustment problems, such as aggression and antisocial behavior, and how they are associated with exposure to family conflict and violence. She has begun to develop and evaluate intervention programs to assist children exposed to frequent and severe interparent violence.

McDonald and Jouriles are co-founders and co-directors of SMU’s Family Research Center. The Center advances knowledge about family functioning and malfunctioning, trains students in clinical psychology and treats families who participate in programs at the research center.

Read the full article.

EXCERPT:

By GoodTherapy.org
Over 15 million children live in homes in which intimate partner violence (IPV) occurs.

“A sizable proportion of these children experience significant mental-health problems, but many appear to experience only mild distress, especially those drawn from community samples,” said Renee McDonald of the Department of Psychology at Southern Methodist University. “Parent– child communications about interparent conflict may represent another important dimension of parenting for children who have been exposed to IPV.”

Children who witness interparent conflict often express curiosity about the conflict. A number of mothers have reported that if asked, they would explain to their children about the conflict. However, to date, few studies have looked at that behavior to identify the influence it would have on the child’s adjustment.

“It seems plausible that mother–child communications about interparent conflict affect children’s understanding of the conflict, and theorists often point to the importance of children’s understanding of their parents’ conflict in influencing children’s adjustment,” said McDonald.

Read the full article.

SMU has an uplink facility on campus for live TV, radio or online interviews. To speak with an SMU expert or to book them in the SMU studio, call SMU News & Communications at 214-768-7650 or UT Dallas Office of Media Relations at 972-883-4321.

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HHS Healthbeat: Predicting Panic Attacks

Nicholas Garlow with the U.S. Department of Health and Human Services created a podcast about the groundbreaking panic attack research of SMU psychologists Dr. Alicia Meuret, Dr. David Rosenfield and Dr. Thomas Ritz.

The Sept. 22 podcast “Predicting Panic Attacks” details the startling findings of Meuret’s newest published study showing significant physiological instability in advance of so-called out-of-the-blue panic attacks.

Read the text.

Listen to the podcast.

EXCERPT:

By Nicholas Garlow
HHS Healthbeat

From the U.S. Department of Health and Human Services, I???m Nicholas Garlow with HHS HealthBeat.

Your body may give you hints that you’re going to have a panic attack, a short period of intense fear and discomfort. Forty-three panic attack sufferers carried portable recorders that measured respiration, heart rate and other bodily functions, over 2,000 hours.

Alice Meuret is at Southern Methodist University.

“Most of the physiological changes took place long before the patients reported that what they felt was a panic attack.” (10 seconds)

To combat attacks, she suggests:

“Changing respiration when noticing symptoms could be effective in avoiding a full blown panic attack. One should try to breathe as little air as possible, to reverse hyperventilation.’ (14 seconds)

Read the text.

Listen to the podcast.

SMU is a nationally ranked private university in Dallas founded 100 years ago. Today, SMU enrolls nearly 11,000 students who benefit from the academic opportunities and international reach of seven degree-granting schools. For more information see www.smu.edu.

SMU has an uplink facility located on campus for live TV, radio, or online interviews. To speak with an SMU expert or book an SMU guest in the studio, call SMU News & Communications at 214-768-7650.

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The Wall Street Journal: Seeing Signs of a Panic Attack Before One Happens

Science journalist Ann Lukits wrote about the groundbreaking panic attack research of SMU psychologists Dr. Alicia Meuret, Dr. David Rosenfield and Dr. Thomas Ritz in the The Wall Street Journal‘s Research Report.

The Sept. 20 article “Seeing Signs of a Panic Attack Before One Happens” details the startling findings of Meuret’s newest published study showing significant physiological instability in advance of so-called out-of-the-blue panic attacks.

Read the full story.

EXCERPT:

By Ann Lukits
The Wall Street Journal

Panic attacks that appeared to strike out of the blue were preceded for almost an hour by significant physiological changes that went undetected by research subjects in a study published in Biological Psychiatry. Panic attacks are intense episodes of terror lasting about 10 minutes that can be unexpected or induced by specific triggers. The disorder, which affects about six million American adults, is twice as common in women as men, according to the National Institute of Mental Health.

Researchers in Texas used portable monitors to record minute-by-minute physiological changes in 43 patients age 23 to 62 with moderate-to-severe panic disorder. Eight indicators, including heart rate, respiration, and skin conductance, an indication of a psychological or physiological reaction to stimuli, were measured during two 24-hour sessions. Patients pressed an event marker when a panic attack occurred and noted the start time. Thirteen attacks averaging eight minutes in length were reported.

Read the full story.

SMU is a nationally ranked private university in Dallas founded 100 years ago. Today, SMU enrolls nearly 11,000 students who benefit from the academic opportunities and international reach of seven degree-granting schools. For more information see www.smu.edu.

SMU has an uplink facility located on campus for live TV, radio, or online interviews. To speak with an SMU expert or book an SMU guest in the studio, call SMU News & Communications at 214-768-7650.

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The Atlantic: The Upside of a Panic Attack: The Worst Is Over Before You Know It

Science journalist Hans Villarica wrote about the groundbreaking panic attack research of SMU psychologists Dr. Alicia Meuret, Dr. David Rosenfield and Dr. Thomas Ritz in the The Atlantic.

The Sept. 16 article “The Upside of a Panic Attack: The Worst Is Over Before You Know It” details the startling findings of Meuret’s newest published study showing significant physiological instability in advance of so-called out-of-the-blue panic attacks.

Read the full story.

EXCERPT:

By Hans Villarica
The Atlantic

There are plenty of misperceptions about panic attacks. People often tell the anxiety ridden to “take a deep breath,” for instance, when they may actually already be taking too much oxygen in by hyperventilating. Indeed, what experts say is that breathing should instead be slow, shallow, and regular, so that a constant, very small stream of air comes in through the nose. Paper bags are optional too, as cupped hands do the trick just as well.

New research aims to debunk another myth: Panic attacks occur completely out of the blue. Though those who panic don’t realize it, their attacks are in fact foreshadowed by minute physiological signals, according to a study led by Southern Methodist University’s Alicia Meuret in the journal Biological Psychiatry. “The hour before panic onset was marked by subtle but significant waves of changes in patient’s breathing and cardiac activity, not just the moment of onset of the attack or even during the attack,” she says. “Our analysis provided us with a whole different pattern.”

That pattern goes like this: Physiological instabilities occur in repeated bouts or waves and are often initiated by heart rate accelerations, followed by changes in breathing and carbon dioxide levels. Ultimately, breathing becomes much shallower, causing a spike in carbon dioxide levels that lead to symptoms that could no longer escape the attention of those who panic. More precisely, they experience terrifying sensations, such as dizziness, air hunger, and shortness of breath.

Read the full story.

SMU is a nationally ranked private university in Dallas founded 100 years ago. Today, SMU enrolls nearly 11,000 students who benefit from the academic opportunities and international reach of seven degree-granting schools. For more information see www.smu.edu.

SMU has an uplink facility located on campus for live TV, radio, or online interviews. To speak with an SMU expert or book an SMU guest in the studio, call SMU News & Communications at 214-768-7650.

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Patch: Panic Attack — It May Not Be a Sneak Attack After All

The nationally distributed online community news service Patch.com has covered the research of SMU psychologist Dr. Alicia Meuret showing panic attacks that seem to strike out-of-the-blue are not without warning after all.

Meuret’s study found significant physiological instability one hour before patients reported feeling a panic attack. The findings suggest potentially new treatments for panic, and re-examination of other “unexpected” medical problems, including seizures, strokes and manic episodes, says Meuret, an assistant professor in the SMU Department of Psychology. She was lead researcher on the study. Dr. David Rosenfield, an associate professor in SMU’s Department of Psychology, was lead statistician.

They reported the results in the journal Biological Psychiatry in the article “Do Unexpected Panic Attacks Occur Spontaneously?

Read the full story.

The online community news service Patch has covered the research of SMU psychologist Dr. Alicia Meuret, which found that panic attacks that seem to strike out-of-the-blue are not without warning after all.

EXCERPT:

By Treacy Colbert
Patch.com

It comes on suddenly — your body ambushes you with dizziness, nausea, sweat, a racing pulse and, worst of all, an impending sense of doom. It’s a panic attack, and while it feels like a sneak attack to most sufferers, a new study shows that many people may actually experience warning signs that simply go undetected.

Sufferers describe symptoms such as pounding heart, dizziness, nausea, a sense of impending doom, sweating, shaking, and shortness of breath, among others.

Not all panic attacks are unexpected. A person who has an intense fear of enclosed spaces or of flying on an airplane can expect that being in a packed elevator or on a flight will cue a panic attack. However, those who suffer from seemingly unpredictable panic attacks often report that the fear of having another random attack can be paralyzing. Sufferers frequently alter their lifestyle and even isolate themselves out of fear that an attack will come on without warning.

But new research from Southern Methodist University (SMU) in Dallas suggests that the body produces warning signs of an impending panic attack as early as an hour beforehand. Significantly, the study reveals that sufferers were unaware of these advance signals. They report their attack as a sudden, out-of-the-blue experience???but don’t seem to sense the physical changes that were gathering and leading up to the full-blown sense of panic.

In the study, researchers monitored physiological changes in 43 patients who suffer from panic disorder. Electrodes and sensors attached to their bodies measured their respiration, analyzing fast or irregular breathing, as well as heart rate, evidence of sweating, and other physiological signs. Participants in the study wore the monitors for 24 hours on two occasions, and a total of 1,960 hours of data was collected.

During this time participants experienced 13 unexpected panic attacks. However, the data analysis revealed that symptoms such as hyperventilating accumulated and gathered prior to the attack but that the panic attack sufferers did not pick up on these signals.

“It is hard to control something that one does not sense,” noted Alicia Meuret, Ph.D., assistant professor of psychology at Southern Methodist University and lead author of the study.

Read the full story.

SMU is a nationally ranked private university in Dallas founded 100 years ago. Today, SMU enrolls nearly 11,000 students who benefit from the academic opportunities and international reach of seven degree-granting schools. For more information see www.smu.edu.

SMU has an uplink facility located on campus for live TV, radio, or online interviews. To speak with an SMU expert or book an SMU guest in the studio, call SMU News & Communications at 214-768-7650.

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Medscape: Panic Attacks Don’t Come Out of the Blue After All

Medscape, the medical blog serving physicians and the healthcare community, has covered the research of SMU psychologist Dr. Alicia Meuret showing panic attacks that seem to strike out-of-the-blue are not without warning after all.

Meuret’s study found significant physiological instability one hour before patients reported feeling a panic attack. The findings suggest potentially new treatments for panic, and re-examination of other “unexpected” medical problems, including seizures, strokes and manic episodes, says Meuret, an assistant professor in the SMU Department of Psychology. She was lead researcher on the study. Dr. David Rosenfield, an associate professor in SMU’s Department of Psychology, was lead statistician.

They reported the results in the journal Biological Psychiatry in the article “Do Unexpected Panic Attacks Occur Spontaneously?

Full article available with free registration with Medscape.

EXCERPT:

By Megan Brooks
Medscape

Panic attacks do not come “out of the blue” but are preceded by physiological changes similar to those that precede seizures, stroke, and even manic episodes, a new study suggests.

“There is reason to believe that waves of physiological instability occur for a substantial period of time before the attack is reported by patients,” Alicia E. Meuret, PhD, an assistant professor from the Department of Psychology, Southern Methodist University, in Dallas, Texas, who led the study, told Medscape Medical News.

The finding may have relevance for other medical disorders where symptoms seemingly happen “out of the blue,” such as seizures, strokes, and even manic episodes, the researchers note.

There is speculation that panic attacks are triggered by marked changes in physiology, in particular breathing, Dr. Meuret explained. However, until now, very little is known on the physiological functioning of those with panic attacks outside the laboratory.

In the current study, 43 patients with panic disorder underwent repeated 24-hour ambulatory monitoring of various physiological indices, including respiration, heart rate, and skin conductance level. During 1960 hours of monitoring, 13 natural panic attacks were recorded.

“We managed to capture spontaneously occurring attacks in these recordings, which we were able to examine closer. The study marks the first to gain an in-depth look into what occurs in early stages before a panic attack occurs,” Dr. Meuret said. The investigators specifically analyzed the 60 minutes before panic onset and during the panic attack.

Full article available with free registration with Medscape.

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UPI: Panic attacks may be predictable

The wire service UPI has covered the research of SMU psychologist Dr. Alicia Meuret showing panic attacks that seem to strike out-of-the-blue are not without warning after all.

Meuret’s study found significant physiological instability one hour before patients reported feeling a panic attack. The findings suggest potentially new treatments for panic, and re-examination of other “unexpected” medical problems, including seizures, strokes and manic episodes, says Meuret, an assistant professor in the SMU Department of Psychology. She was lead researcher on the study. Dr. David Rosenfield, an associate professor in SMU’s Department of Psychology, was lead statistician.

They reported the results in the journal Biological Psychiatry in the article “Do Unexpected Panic Attacks Occur Spontaneously?

Read the full wire story.

EXCERPT:

UPI
DALLAS, July 27 (UPI) — Panic attacks that seem to strike out-of-the-blue are not without warning after all, U.S. researchers say.

Lead researcher Alicia E. Meuret, a psychologist at Southern Methodist University in Dallas, says the study is based on 24-hour monitoring of panic sufferers while they went about their daily activities. Portable recorders captured changes in respiration, heart rate and other bodily functions, Meuret says.

The researchers captured panic attacks as they occurred and discovered waves of significant physiological instability for at least 60 minutes before patients’ awareness of the panic attacks, Meuret says.

Read the full wire story.

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Out-of-the-blue panic attacks aren’t without warning; data show subtle changes before patients’ aware of attack

Panic attacks that seem to strike sufferers out-of-the-blue are not without warning after all, according to new research.

A study based on 24-hour monitoring of panic sufferers while they went about their daily activities captured panic attacks as they happened and discovered waves of significant physiological instability for at least 60 minutes before patients’ awareness of the panic attacks, said psychologist Alicia E. Meuret at Southern Methodist University in Dallas.

In a rare study in which patients were monitored around-the-clock, portable recorders captured changes in respiration, heart rate and other bodily functions, said Meuret, lead researcher on the study.

The new findings suggest sufferers of panic attacks may be highly sensitive to — but unaware of — an accumulating pattern of subtle physiological instabilities that occur before an attack, Meuret said.

Monitoring data also showed patients were hyperventilating on a chronic basis.

Electrodes%202%20684.jpg
Simulated panic sufferer and monitoring equipment. (Photo: SMU)

“The results were just amazing,” Meuret said. “We found that in this hour preceding naturally occurring panic attacks, there was a lot of physiological instability. These significant physiological instabilities were not present during other times when the patient wasn’t about to have a panic attack.”

It is notable that patients reported the attacks as unexpected, lacking awareness of either the coming attack or their changing physiology.

“The changes don’t seem to enter the patient’s awareness,” Meuret said. “What they report is what happens at the end of the 60 minutes — that they’re having an out-of-the blue panic attack with a lot of intense physical sensations. We had expected the majority of the physiological activation would occur during and following the onset of the panic attack. But what we actually found was very little additional physiological change at that time.”

Unexpected attacks have been a mystery; little research to explain them
The diagnostic standard for psychological disorders, the DSM-IV, defines panic attacks as either expected or unexpected.

Those that are expected, or cued, occur when a patient feels an attack is likely, such as in closed spaces, while driving or in a crowded place.

“But in an unexpected panic attack, the patient reports the attack to occur out-of-the-blue,” Meuret said. “They would say they were sitting watching TV when they were suddenly hit by a rush of symptoms, and there wasn’t anything that made it predictable.”

To sufferers and researchers alike, the attacks are a mystery.

Change-point analysis uncovered physiological instabilities one hour before attacks
Meuret and her colleagues discovered the significant physiological instabilities using change-point analysis, a statistical method that searches for points when changes occur in a “process” over time.

“This analysis allowed us to search through patients’ physiological data recorded in the hour before the onset of their panic attacks to determine if there were points at which the signals changed significantly,” said psychologist David Rosenfield of SMU, lead statistician on the project.

The study is significant not only for panic disorder, but also for other medical problems where symptoms and events have seemingly “out-of-the blue” onsets, such as seizures, strokes and even manic episodes.

“I think this method and study will ultimately help detect what’s going on before these unexpected events and help determine how to prevent them,” Meuret said. “If we know what’s happening before the event, it’s easier to treat it.”

Meuret, an assistant professor in the SMU Department of Psychology, reported the results in the journal Biological Psychiatry in the article “Do Unexpected Panic Attacks Occur Spontaneously?” Rosenfield is an associate professor in SMU’s Department of Psychology.

A multi-disciplinary collaboration, other authors on the study were psychologist Thomas Ritz, SMU Department of Psychology; psychologist Frank H. Wilhelm, University of Salzburg, Austria; electrical engineer Enlu Zhou, University of Illinois at Urbana-Champaign; and psychologist Ansgar Conrad and psychiatrist Walton T. Roth, both of Stanford University.

Meuret discusses the research in an SMU Research youtube video.

Subtle physical changes impact panic sufferers more severely
People with panic disorder probably won’t be surprised by the results, Meuret said.

By definition, the majority of the 13 symptoms of panic attack are physiological: shortness of breath, heart racing, dizziness, chest pain, sweating, hot flashes, trembling, choking, nausea and numbness. Only three are psychological: feeling of unreality, fear of losing control and fear of dying.

“Most patients obviously feel that there must be something going on physically,” Meuret said. “They worry they’re having a heart attack, suffocating or going to pass out. Our data doesn’t indicate there’s something inherently wrong with them physically, neither when they are at rest nor during panic. The fluctuations that we discovered are not extreme; they are subtle. But they seem to build up and may result in a notion that something catastrophic is going on.”

Notably, the researchers found that patients’ carbon dioxide, or C02, levels were in an abnormally low range, indicating the patients were chronically hyperventilating. These levels rose significantly shortly before panic onset and correlated with reports of anxiety, fear of dying and chest pain.

“It has been speculated, but never verified with data recordings in daily life, that increases in CO2 cause feelings of suffocation and can be panic triggers,” Meuret said.

Fanny pack monitor tracked physiological changes before, during and after attacks
To capture the physiological data, 43 patients wore the monitoring devices for 24 hours on two separate occasions. The researchers collected 1,960 hours of ambulatory monitoring data, including 13 unexpected panic attacks.

Participants, all of whom suffer from panic disorder, were each outfitted with an array of electrodes and sensors attached to various parts of their bodies.

The ambulatory monitoring device was toted in a small waist pack the patients wore. Also included was a portable capnometer to measure CO2 collected from exhaled breath. The physiological responses were recorded continuously as digital data in a time series.

Each monitoring pack included a “panic button.” Patients were instructed to press the button if they had an attack and to write down their symptoms. By triggering the panic button, patients inserted a marker into the time-series data, marking the moment the attack began.

The sensors measured eight physiological indices, including changes in respiration, such as how deep, fast or irregular people were breathing; cardiac activity; and evidence of sweating.

Data analysis found strikingly significant changes in the hour before attacks
From the nearly 2,000 hours of data, the change-point analysis program allowed the researchers to slice out 70-minute periods around each of the 13 panic attacks — from one hour before onset until 10 minutes after the attacks began.

For each index, the program checked for any significant change in the signal that remained stable over a specified period of time.

Those results were collapsed across all 13 panic attacks, with minute-by-minute averages. The information was then compared to a 70-minute control period randomly chosen during non-panic periods.

“We found 15 subtle but significant changes an hour before the onset of the panic attacks that followed a logical physiological pattern. These weren’t present during the non-panic period,” Meuret said.

“Why they occurred, we don’t know. We also can’t say necessarily they were causal for the panic attacks. But the changes were strikingly and significantly different to what was observed in the non-panic control period,” she said.

Findings prompt look at “panic” definition and treatment
The study’s results invite a reconsideration of the DSM diagnostic definition that separates “expected” from “unexpected” attacks, Meuret said.

Also, the study might explain why medication or interventions aimed at normalizing respiration for treating panic are effective, she said. Medication generally buffers arousal, keeping it low and regular, thereby preventing unexpected panic attacks.

For psychological treatments such as Cognitive Behavior Therapy (CBT), the results are more challenging. CBT requires a patient to focus on examining thoughts to prevent an attack.

“But a patient can’t work on something they don’t know is going to happen,” Meuret said.

New methodology can be universalized to other unexpected medical problems
The study’s use of change-point analysis can be applied to other medical issues. Traditional statistics are ineffective at analyzing such data, Meuret said, because they look only at level differences at pre-determined times and won’t find a signal for an unknown point.

“This study is a step toward more understanding and hopefully opening more doors for research on medical events that are difficult to predict. The hope is that we can then translate these findings into new therapies,” she said.

The research was funded by the National Institutes of Mental Health, Department of Veterans Affairs and the Beth and Russell Siegelman Foundation. — Margaret Allen

SMU is a nationally ranked private university in Dallas founded 100 years ago. Today, SMU enrolls nearly 11,000 students who benefit from the academic opportunities and international reach of seven degree-granting schools. For more information see www.smu.edu.

SMU has an uplink facility located on campus for live TV, radio, or online interviews. To speak with an SMU expert or book an SMU guest in the studio, call SMU News & Communications at 214-768-7650.

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Cosmopolitan: Feeling stressed and panicked? Don’t take a deep breath!

Cosmopolitan magazine has taken note of the research of SMU psychology department Assistant Professor Alicia E. Meuret. Their Jan. 3 article “The 3-Second Trick to Beat Stress” tells readers that if they want to conquer that panicky feeling of suffocation when stressed and feeling anxious — forget about taking a deep breath.

EXCERPT:

By Zoe Ruderman
Cosmopolitan

You’ve probably been told that one of the first things you should do when you’re feeling panicky is to take a deep breath. But according to a new study, not only will that technique not help you calm down, but it could make you freak out even more.

Researchers at Southern Methodist University in Dallas say that found that when a person faced with nerve-wracking situations takes deep, slow breaths, she may feel like she’s hyperventilating, therefore making her more worked up. So what should you do when your boss calls you into a meeting you forgot about or you’re stuck in traffic? Take shallow, slow breaths.

Read the full story.

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Live Science: Less is more when breathing to relieve panic

Live Science news site interviewed SMU psychology department Assistant Professor Alicia E. Meuret for an article about her research findings that the hyperventilation that comes with panic attacks can be alleviated by breathing less — not more. The Dec. 26 article “To Stave Off Panic, Don’t Take a Deep Breath” tells readers that deep breathing reduces carbon dioxide in the system, which in turn causes symptoms like dizziness and numbness.

EXCERPT:

By Stephanie Pappas
Live Science

A new treatment for the feeling of suffocation that accompanies a panic attack focuses on getting patients to breathe less.

The treatment, which involves a technique for altering your breathing, is more effective at alleviating both short-term panic disorder symptoms and hyperventilation than traditional psychological therapy, and it may make people less prone to panic attacks in the first place, said study leader Alicia Meuret of Southern Methodist University in Dallas.

The treatment is called capnometry-assisted respiratory training, or CART.

“In a certain way, CART was superior because it was changing the psychological symptoms and the abnormal physiological state,” Meuret told LiveScience.

Read the full story.

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A new breathing therapy reduces panic and anxiety by reversing hyperventilation

Breakthrough “CART” treatment better than traditional cognitive therapy at altering hyperventilation and panic symptoms

http://www.youtube.com/watch?v=AcQsJnLBWpE

A new treatment program teaches people who suffer from panic disorder how to reduce the terrorizing symptoms by normalizing their breathing.

The method has proved better than traditional cognitive therapy at reducing both symptoms of panic and hyperventilation, according to a new study.

The biological-behavioral treatment program is called Capnometry-Assisted Respiratory Training, or CART, said psychologist and panic disorder expert Alicia E. Meuret at Southern Methodist University in Dallas.

CART helps patients learn to breathe in such a way as to reverse hyperventilation, a highly uncomfortable state where the blood stream operates with abnormally low levels of carbon dioxide, said Meuret, one of the researchers conducting the study.

Hyperventilation, a state of excessive breathing, results from deep or rapid breathing and is common in patients with panic disorders.

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To book a live or taped interview with Alicia Meuret in the SMU News Broadcast Studio call SMU News at 214-768-7650 or email news@smu.edu.

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“We found that with CART it’s the therapeutic change in carbon dioxide that changes the panic symptoms — and not vice versa,” Meuret said.

CART: Breathing exercises twice a day
During the treatment, patients undergo simple breathing exercises twice a day. A portable capnometer device supplies feedback during the exercises on a patient’s CO2 levels. The goal of these exercises is to reduce chronic and acute hyperventilation and associated physical symptoms. This is achieved by breathing slower but most importantly more shallowly. Contrary to lay belief, taking deep breaths actually worsens hyperventilation and symptoms.

“Most panic-disorder patients report they are terrified of physical symptoms such as shortness of breath or dizziness,” Meuret said. “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.”

The findings, “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. The Beth & Russell Siegelman Foundation funded the research.

CART breathing a proven biological therapy
The study pitted CART against a conventional cognitive therapy treatment, or CT. Traditional CT teaches patients techniques aimed at helping them change and reverse catastrophic thoughts in order to reduce fear and panic.

In the CART-CT study, 41 patients were assigned to complete either a CART or CT treatment program for panic disorder and agoraphobia, a fear of being trapped with no means of escape or help.

Both treatment programs were equally effective in reducing symptoms, said Meuret. But CART was the only treatment to physiologically alter panic symptoms by actively reversing hyperventilation in the patients. Cognitive therapy didn’t change the respiratory physiology, said Meuret.

Treatment helps patients address terror associated with panic
The study is the second randomized control trial to measure CART’s effectiveness. By reversing hyperventilation, patients reported a new ability to reduce panic symptoms by means of changing their respiration.

With CT, Meuret said, if a patient reports shortness of breath, the therapist challenges the assumption by asking how often the person actually has suffocated during a panic attack, then hopes that will reverse the patient’s thinking.

“I found that process very challenging for some of my patients because it acknowledges the symptom but says it’s not a problem,” Meuret said.

“CART, however, 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,” she said. “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.”

Broader study planned to measure CART
The researchers plan to branch out with their studies on CART by taking the program into the community, particularly to ethnic minorities. They believe CART is a more universally understood treatment due to its physical exercises — as opposed to cognitive therapy’s more intellectual methods — and therefore more accessible to a broader range of people with varying levels of education and different cultural backgrounds. Ongoing studies will test the efficacy of CART in patients with asthma and fear of blood.

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 research was funded by the Beth & Russell Siegelman Foundation. — Austin Reed

SMU is a private university in Dallas where nearly 11,000 students benefit from the national opportunities and international reach of SMU’s seven degree-granting schools. For more information see www.smu.edu.

SMU has an uplink facility on campus for live TV, radio or online interviews. To speak with Dr. Meuret or to book an interview with her in the SMU studio, call SMU News & Communications at 214-768-7650.

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UPI: Abusive mothers can improve parenting

UPI covered the research of SMU psychologists Ernest Jouriles, Renee McDonald, David Rosenfield and Deborah Corbitt-Shindler in a July 30 story “Abusive mothers can improve parenting.”

UPI covered the research of SMU psychologists Ernest Jouriles, Renee McDonald, David Rosenfield and Deborah Corbitt-Shindler in a July 30 story “Abusive mothers can improve parenting.”

EXCERPT:

DALLAS, July 30 (UPI) — Abusive mothers, who are taught parenting skills and given emotional support, can improve their parenting skills, two U.S. researchers say.

Ernest Jouriles and Renee McDonald of Southern Methodist University in Dallas say parenting improved in impoverished, neglectful, abusive mothers after home visits, classes and emotional support from therapists.

The study, published in the Journal of Family Psychology, says large improvements in mothers’ parenting were observed in families given instruction and emotional support compared to families that did not receive the services.

Jouriles is professor and chairman of the SMU Psychology Department. McDonald and Rosenfield are associate professors. Corbitt-Shindler is a psychology department doctoral candidate.

Read the full story:Abusive mothers can improve parenting

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Abusive mothers improve their parenting after home visits, classes and emotional support from therapists

Mothers who live in poverty and who have abused their children can stop if they are taught parenting skills and given emotional support.

A new study has found that mothers in families in which there is a history of child abuse and neglect were able to reduce how much they cursed at, yelled at, slapped, spanked, hit or rejected their children after a series of home visits from therapists who taught them parenting skills.

There were large improvements in mothers’ parenting in families that received the intensive services, compared to families that did not receive the services, according to SMU psychologists Ernest Jouriles and Renee McDonald at Southern Methodist University in Dallas, two of the study’s eight authors.

As a result of the intensive, hands-on training, the women in the study said they felt they did a better job managing their children’s behavior, said Jouriles and McDonald. The mothers also were observed to use better parenting strategies, and the families were less likely to be reported again for child abuse.

“Although there are many types of services for addressing child maltreatment, there is very little scientific data about whether the services actually work,” said McDonald. “This study adds to our scientific knowledge and shows that this type of service can actually work.”

Help for violent families
The parenting training is part of a program called Project Support, developed at the Family Research Center at SMU and designed to help children in severely violent families.

The study appears in the current issue of the quarterly Journal of Family Psychology. The article is titled “Improving Parenting in Families Referred for Child Maltreatment: A Randomized Controlled Trial Examining Effects of Project Support.” SMU psychologist David Rosenfield also authored the study.

The research was funded by the federal Interagency Consortium on Violence Against Women and Violence Within the Family, along with the Texas-based Hogg Foundation for Mental Health.

“Child maltreatment is such an important and costly problem in our society that it seems imperative to make sure that our efforts — and the tax dollars that pay for them — are actually solving the problem,” said Jouriles. He and McDonald are co-founders and co-directors of the SMU Family Research Center.

In 2007, U.S. child welfare agencies received more than 3 million reports of child abuse and neglect, totaling almost 6 million children, according to the U.S. Department of Health and Human Services.

Poor and single with children
The study worked with 35 families screened through the Texas child welfare agency Child Protective Services, CPS. The parents had abused or neglected their children at least once, but CPS determined it best the family stay together and receive services to improve parenting and end the maltreatment.

In all the families, the mother was legal guardian and primary caregiver and typically had three children. On average she was 28, single and had an annual income of $10,300. Children in the study ranged from 3 to 8 years old.

Half the families in the study received Project Support parenting education and support. The other half received CPS’s conventional services.

New parenting skills + help
Mental health service providers met with the 17 Project Support families weekly in their homes for up to 6 months.

During that time, mothers, and often their husbands or partners, were taught 12 specific skills, including how to pay attention and play with their children, how to listen and comfort them, how to offer praise and positive attention, how to give appropriate instructions and commands, and how to respond to misbehavior.

Also, therapists provided the mothers with emotional support and helped them access materials and resources through community agencies as needed, such as food banks and Medicaid. The therapists also helped mothers evaluate the adequacy and safety of the family’s living arrangements, the quality of their child-care arrangements and how to provide enough food with so little money.

Services provided to families receiving traditional child welfare services varied widely. The range of services included parenting classes at a church or agency, family therapy or individual counseling, videotaped parenting instruction, anger-management help, GED classes and contact by social workers in person or by phone.

Fewer recurrences of abuse
Only 5.9 percent of the families trained through Project Support were later referred to CPS for abuse, compared with almost 28 percent of the control group, the researchers found.

“The results of this study have important implications for the field of child maltreatment,” said SMU’s Rosenfield.

Project Support was launched in 1996 to address the mental health problems of maltreated children and children exposed to domestic violence, both of which often lead to considerable problems for children later in life, such as substance abuse, interpersonal violence and criminal activity. Previous studies have shown the program can improve children’s psychological adjustment as well as mothers’ ability to parent their children appropriately and effectively, according to the researchers.

Project Support: A promising practice
With funding from the U.S. Department of Justice’s Office of Juvenile Justice and Delinquency Prevention, Project Support has been included in a study evaluating 15 “promising practices” nationally for helping children who live in violent families.

Jouriles is professor and chairman of the SMU Psychology Department. McDonald and Rosenfield are associate professors.

Other researchers were William Norwood, University of Houston; Laura Spiller, Midwestern State University; Nanette Stephens, University of Texas; Deborah Corbitt-Shindler, SMU; and Miriam Ehrensaft, City University of New York.

SMU is a private university in Dallas where nearly 11,000 students benefit from the national opportunities and international reach of SMU’s seven degree-granting schools. For more information see www.smuresearch.com.