Paul Lehrer, Ph.D.,(1) Maria Karavidas, Psy.D.,(1) Linda Kranitz, J.D.(2)

(1) University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway, NJ, USA (2) Rutgers University, Piscataway, NJ, USA

The purpose of this study was to evaluate the effectiveness of a psychological treatment program for comorbid asthma and panic disorder. The two disorders have high comorbidity, and a substantial overlap in symptoms, Patients frequently confuse the two problems; but treating the "wrong" problem can be disastrous, sometimes fatal.

The goals of the program were 1) to teach patients to differentiate between asthma and panic symptoms, 2) to assist patients in managing asthma to avoid experiencing unnecessary symptoms, 3) to teach patients skills for managing panic symptoms, and 4) to eliminate symptoms that interfere with daily activity.

Our first protocol, involving 14 weekly sessions, was tried on 10 patients. Assessments were made at Sessions 1,4, 10, 14, and at a one-month follow-up. There was a high dropout rate (n=5) at about Session 8. We therefore instituted an 8-session protocol with assessments at Sessions 1, 4, 8, and two monthly followups, which we have thus far tried on six patients, with no dropouts.

Patients did daily monitoring of symptoms, peak flow, and use of medication.

We taught patients: 1) to differentiate asthma from panic symptoms, 2) proper use of asthma medication, 3) Jacobson's progressive muscle relaxation, 4) slow shallow abdominal breathing, 5) Barlow's panic control method (cognitive restructuring and exposure to feared situations, and 6) assertiveness.

For both protocols, there were apparent improvements in pulmonary function, asthma symptom report, rescue medication usage, and panic symptom report. There were tendencies for improvement in pulmonary function, decrease in Albuterol use, and significant decreases in both asthma and panic symptoms.