LUCHAR - Latinos Using Counseling for Help With Asthma and Anxiety Reduction
| Status: | Completed |
|---|---|
| Conditions: | Asthma, Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 7/26/2018 |
| Start Date: | July 2010 |
| End Date: | December 2013 |
Adaptation of a Behavioral Treatment for Latinos With Panic Disorder and Asthma
The research plan involves two aims: 1) Cultural adaptation of the Panic-Asthma Treatment and
2) a randomized, placebo-controlled pilot study. Participants will be primarily recruited
from two major, inner-city hospitals in the Bronx, NY. Diagnosis of Panic Disorder (PD) will
be based on the Structured Clinical Interview for DSM-IV. Diagnosis of asthma will be based
on national guidelines. The first year of the project will be devoted to approximately 5
focus groups with Latino (primarily Puerto Rican) participants, pilot treatment and
participant feedback. The protocol will be adapted based on key cultural issues that are
systematically observed during Phase 1. During Years 2-3, 40 participants with PD and asthma
will be randomized into two treatment arms: Panic-Asthma Treatment and an active placebo
condition involving music therapy and paced breathing at resting respiration rates. Each
treatment will involve 8 weekly sessions. An interviewer, who will be blind to treatment
condition, will conduct assessments at pre-treatment, mid-treatment, post-treatment, and
3-month follow-up. The primary hypotheses are that participants in the Panic-Asthma treatment
group will have greater decreases than subjects in the placebo condition on the PD severity
scale and albuterol use (i.e., rescue asthma medication) from pre-test to post-test and
across 3-month follow-up.
2) a randomized, placebo-controlled pilot study. Participants will be primarily recruited
from two major, inner-city hospitals in the Bronx, NY. Diagnosis of Panic Disorder (PD) will
be based on the Structured Clinical Interview for DSM-IV. Diagnosis of asthma will be based
on national guidelines. The first year of the project will be devoted to approximately 5
focus groups with Latino (primarily Puerto Rican) participants, pilot treatment and
participant feedback. The protocol will be adapted based on key cultural issues that are
systematically observed during Phase 1. During Years 2-3, 40 participants with PD and asthma
will be randomized into two treatment arms: Panic-Asthma Treatment and an active placebo
condition involving music therapy and paced breathing at resting respiration rates. Each
treatment will involve 8 weekly sessions. An interviewer, who will be blind to treatment
condition, will conduct assessments at pre-treatment, mid-treatment, post-treatment, and
3-month follow-up. The primary hypotheses are that participants in the Panic-Asthma treatment
group will have greater decreases than subjects in the placebo condition on the PD severity
scale and albuterol use (i.e., rescue asthma medication) from pre-test to post-test and
across 3-month follow-up.
Asthma and panic disorder (PD) share strikingly similar phenomenology. Respiratory related
symptoms, such as dyspnea, dizziness, chest tightness, feelings of choking and sensations of
smothering are common in both disorders. The overlap in symptoms between asthma and panic may
lead an individual to mistake a panic attack as an asthma attack. In order to better
understand this overlap, we hypothesized that participants who received Cognitive Behavioral
Psychophysiological Therapy (CBPT) would display greater reductions in PD severity and
improvements in asthma control at post- treatment and 3-month follow-up. We predicted that
improvements in PD severity in the CBPT group would be mediated by reductions in the
perceived physical consequences of anxiety. We selected music therapy and paced breathing at
each participant's average respiration rate for the comparison active treatment. Randomized
participants will undergo either the CBPT or MRT protocol, be given the same psychological
assessments, and have their physiological data collected.
symptoms, such as dyspnea, dizziness, chest tightness, feelings of choking and sensations of
smothering are common in both disorders. The overlap in symptoms between asthma and panic may
lead an individual to mistake a panic attack as an asthma attack. In order to better
understand this overlap, we hypothesized that participants who received Cognitive Behavioral
Psychophysiological Therapy (CBPT) would display greater reductions in PD severity and
improvements in asthma control at post- treatment and 3-month follow-up. We predicted that
improvements in PD severity in the CBPT group would be mediated by reductions in the
perceived physical consequences of anxiety. We selected music therapy and paced breathing at
each participant's average respiration rate for the comparison active treatment. Randomized
participants will undergo either the CBPT or MRT protocol, be given the same psychological
assessments, and have their physiological data collected.
Inclusion Criteria:
- DSM-IV criteria for current PD with or without agoraphobia
- fluency in spoken English or Spanish
- no changes in prescribed levels of panicolytic medication for two months prior to the
study and no changes in panicolytic medication during the two months of the active
protocol
- history or presence of episodic symptoms of airflow obstruction, namely, wheezing,
shortness of breath, chest tightness, or cough
- airflow obstruction showing FEV1 < 80% predicted and FEV1/FVC < 65% or below the lower
limit of normal
- airflow obstruction must be at least partly reversible, as demonstrated by:
- Positive Bronchodilator test in past year from Medical Chart Review or Baseline
session
- Positive Bronchodilator test during past 10 years (from Medical Chart Review) and
asthma symptoms reported past 12 months (from Medical Chart Review or Baseline
Questionnaires)
- Improvement in PEF of ≥20% from Medical Chart Review past 10 years (from Medical Chart
Review) and asthma symptoms reported past 12 months (from Medical Chart Review or
Baseline Questionnaires)
- Clinical improvement in asthma symptoms after initiation of anti-inflammatory
medication, as documented in medical records.
Exclusion Criteria:
- evidence of active bipolar disorder or psychosis
- mental retardation or organic brain syndrome
- current alcohol or substance abuse/dependence
- foreign body aspiration, vocal cord dysfunction, or other pulmonary diseases
- history of smoking 20 pack-years or more
- history consistent with emphysema, sarcoidosis, bronchiectasis, pulmonary
tuberculosis, lung cancer, cardiovascular or neurological disease
- current participation in alternative psychotherapy for anxiety or panic for less than
6 months
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