{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T03:18:23Z","timestamp":1790738303082,"version":"4.1.0"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T00:00:00Z","timestamp":1748822400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Breath-hold divers are known for their exceptional breathing control and reduced carbon dioxide (CO<jats:sub>2<\/jats:sub>) sensitivity due to training adaptations. In contrast, individuals with panic disorder (PD) often exhibit heightened CO<jats:sub>2<\/jats:sub> sensitivity. This study aimed to explore the potential clinical applications of the diving response (DR), particularly cold facial immersion (CFI), in mitigating panic-related symptoms and cognitions by modulating CO<jats:sub>2<\/jats:sub> sensitivity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study investigated the effects of the CFI task on individuals with PD and a comparison group. Changes in heart rate, respiration rate, and psychological measures were assessed before and after a CO<jats:sub>2<\/jats:sub> challenge to determine whether the CFI task could reduce CO<jats:sub>2<\/jats:sub> sensitivity and panic-related symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The results did not support the efficacy of the CFI task in reducing physiological markers of CO<jats:sub>2<\/jats:sub> sensitivity\u2014specifically, heart rate and respiration rate\u2014following the CO<jats:sub>2<\/jats:sub> challenge in either the clinical or comparison group, potentially due to the small sample size. However, significant reductions in both physiological and cognitive symptoms of panic were observed in the clinical group following the CFI task.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>As hypothesized, the CFI task demonstrated anxiolytic effects in individuals with PD by reducing self-reported anxiety and panic symptoms. These findings highlight the potential of the CFI task for clinical application in the treatment of panic disorder, warranting further research with larger samples.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyt.2025.1533019","type":"journal-article","created":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T05:22:25Z","timestamp":1748841745000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["The implications of the diving response in altering carbon dioxide sensitivity as measured by changes in heart rate, respiration rate and psychological measures in panic disorder patients"],"prefix":"10.3389","volume":"16","author":[{"given":"Peter","family":"Kyriakoulis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine Lissette","family":"Caballero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1007\/s12264-023-01088-9","article-title":"Brain mechanisms underlying panic attack and panic disorder","volume":"40","author":"Guan","year":"2024","journal-title":"Neurosci Bull"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/0006-3223(94)00296-F","article-title":"Rebreathing tests in panic disorder","volume":"38","author":"Papp","year":"1995","journal-title":"Biol Psychiatry"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.150.8.1149","article-title":"Carbon dioxide hypersensitivity, hyperventilation, and panic disorder","volume":"150","author":"Papp","year":"1993","journal-title":"Am J Psychiatry"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/S1516-4446(12)70053-3","article-title":"Panic disorder and the respiratory system: clinical subtype and challenge tests","volume":"34","author":"Freire","year":"2012","journal-title":"Braz J Psychiatry"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.141.7.857","article-title":"Response to hyperventilation in a group of patients with panic disorder","volume":"141","author":"Gorman","year":"1984","journal-title":"Am J Psychiatry"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1993.01820160076009","article-title":"False suffocation alarms, spontaneous panics, and related conditions","volume":"50","author":"Klein","year":"1993","journal-title":"Arch Gen Psychiatry"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3956(94)90027-2","article-title":"Hypercapneic ventilatory response in patients with panic disorder before and after alprazolam treatment and in pre- and postmenstrual women","volume":"28","author":"Fishman","year":"1994","journal-title":"J Psychiatry Res"},{"key":"B8","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/0005-7916(82)90032-5","article-title":"Effects of carbon dioxide-oxygen inhalations on subjective anxiety and some neurovegetative parameters","volume":"13","author":"Griez","year":"1982","journal-title":"J Behav Ther Exp Psychiatry"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-1781(00)00135-9","article-title":"Double-blind acute clonazepam vs. placebo in carbon dioxide-induced panic attacks","volume":"94","author":"Nardi","year":"2000","journal-title":"Psychiatry Res"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2008.07.011","article-title":"Panic disorder and control of breathing","volume":"167","author":"Nardi","year":"2009","journal-title":"Respir Physiol Neurobiol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/0165-1781(94)90085-X","article-title":"Carbon dioxide\/oxygen challenge test in panic disorder","volume":"52","author":"Perna","year":"1994","journal-title":"Psychiatry Res"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2021.784884","article-title":"The implications of the diving response in reducing panic symptoms","volume":"12","author":"Kyriakoulis","year":"2021","journal-title":"Front Psychiatry"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.5960\/dzsm.2024.613","article-title":"Physiological challenges and adaptations in competitive freediving","volume":"75","author":"Tetzlaff","year":"2024","journal-title":"Dtsch Z Sportmed"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.47363\/JCRRR\/2024(5)195","article-title":"The cardio-respiratory mechanisms involved in the diving response adaptation and breath-hold training effects in freedivers","volume":"5","author":"Kyriakoulis","year":"2024","journal-title":"J Cardiol Res Rev Rep"},{"key":"B15","doi-asserted-by":"publisher","first-page":"20","DOI":"10.36959\/987\/225","article-title":"Physiological adaptations of apnea-conditioned athletes and their implications for synchronized swimmer\u2019s performance","volume":"1","author":"Konstantinidou","year":"2017","journal-title":"Arch Sports Med"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-097X.2011.01070.x","article-title":"Heart rate variability in free diving athletes","volume":"32","author":"Christoforidi","year":"2012","journal-title":"Clin Physiol Funct Imaging"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2021.681531","article-title":"Chemoreflex control as the cornerstone in immersion water sports","volume":"12","author":"Gonz\u00e1lez","year":"2021","journal-title":"Front Physiol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0838.2011.01391.x","article-title":"Effects of two weeks of daily apnea training on diving response, spleen contraction, and erythropoiesis in novel subjects","volume":"23","author":"Engan","year":"2013","journal-title":"Scandinavian J Med Sci Sports"},{"key":"B19","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1176\/appi.ajp.157.4.493","article-title":"Neuroanatomical hypothesis of panic disorder, revised","volume":"157","author":"Gorman","year":"2000","journal-title":"Am J Psychiatry"},{"key":"B20","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1001\/archpsyc.1993.01820160076009","article-title":"False suffocation alarms, spontaneous panics, and related conditions: An integrative hypothesis","volume":"50","author":"Klein","year":"1993","journal-title":"Arch Gen Psychiatry"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/S0924-9338(97)83297-X","article-title":"The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability","volume":"12","author":"Sheehan","year":"1997","journal-title":"Eur Psychiatr"},{"key":"B22","volume-title":"User\u2019s Guide for the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I, Version 2.0)","author":"First","year":"1995"},{"key":"B23","volume-title":"Structured Clinical Interview for DSM-IV Axis I Disorders: Patient Edition, SCID-I\/P","author":"First","year":"1996"},{"key":"B24","volume-title":"Using multivariate statistics","author":"Tabachnick","year":"2013"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1007\/s00421-008-0936-y","article-title":"Repeated apneas do not affect the hypercapnic ventilatory response in the short term","volume":"105","author":"Andersson","year":"2009","journal-title":"Eur J Appl Physiol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e31820a4e0c","article-title":"Breath-hold diving: Respiratory function on the longer term","volume":"43","author":"Walterspacher","year":"2011","journal-title":"Med Sci Sports Exercise"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1123\/ijspp.2013-0308","article-title":"Modified ventilatory response characteristics to exercise in breath-hold divers","volume":"9","author":"Roecker","year":"2014","journal-title":"Int J Sports Physiol Perform"},{"key":"B28","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1159\/000364830","article-title":"Are respiratory abnormalities specific for panic disorder? A meta-analysis","volume":"70","author":"Grassi","year":"2014","journal-title":"Neuropsychobiology"},{"key":"B29","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1111\/j.1600-0838.2005.00440.x","article-title":"The human diving response, its function, and its control","volume":"15","author":"Foster","year":"2005","journal-title":"Scandinavian J Med Sci Sports"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1177\/026988111452736331","article-title":"Brainstem response to hypercapnia: A symptom provocation study into the pathophysiology of panic disorder","volume":"28","author":"Goossens","year":"2014","journal-title":"J Psychopharmacol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2014.02.010","article-title":"Divers revisited: the ventilatory response to carbon dioxide in experienced scuba divers","volume":"108","author":"Earing","year":"2014","journal-title":"Respir Med"},{"key":"B32","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1007\/s11055-015-0195-4","article-title":"Changes in cerebral blood flow on performance of a diving reaction in humans","volume":"46","author":"Baranova","year":"2016","journal-title":"Neurosci Behav Physiol"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1007\/s004210050668","article-title":"Effects of physical and apnea training on apneic time and the diving response in humans","volume":"82","author":"Schagatay","year":"2000","journal-title":"Eur J Appl Physiol"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.22462\/01.03.2019.2","article-title":"Cold water submersion attenuates post-submersion aerobic performance and orthostatic tolerance irrespective of partial rehydration with water","volume":"46","author":"Hess","year":"2019","journal-title":"Undersea Hyperbaric Med"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.156.5.739","article-title":"Panic disorder subtypes: Differential responses to CO2 challenge","volume":"156","author":"Biber","year":"1999","journal-title":"Am J Psychiatry"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1016\/S1569-9048(02)00149-0","article-title":"A breath-holding challenge in panic disorder patients, their healthy first-degree relatives, and normal controls","volume":"133","author":"Nardi","year":"2002","journal-title":"Respir Physiol Neurobiol"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2005.07.007","article-title":"Psychopathological profile of 35% CO2 challenge test\u2013induced panic attacks: a comparison with spontaneous panic attacks","volume":"47","author":"Nardi","year":"2006","journal-title":"Compr Psychiatry"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1002\/da.20165","article-title":"35% Carbon dioxide and breath-holding challenge tests in panic disorder: A comparison with spontaneous panic attacks","volume":"23","author":"Nardi","year":"2006","journal-title":"Depression Anxiety"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2007.07.015","article-title":"Panic disorder respiratory subtype: a comparison between responses to hyperventilation and CO2 challenge tests","volume":"157","author":"Freire","year":"2008","journal-title":"Psychiatry Res"},{"key":"B40","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1176\/ajp.146.6.779","article-title":"Hypersensitivity to carbon dioxide in panic disorder","volume":"146","author":"Papp","year":"1989","journal-title":"Am J Psychiatry"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1590\/S0100-879X2002000700004","article-title":"Respiratory panic disorder subtype and sensitivity to the carbon dioxide challenge test","volume":"35","author":"Valenca","year":"2002","journal-title":"Braz J Med Biol Res"},{"key":"B42","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1037\/0033-295X.108.1.4","article-title":"A modern learning theory perspective on the etiology of panic diorder","volume":"108","author":"Bouton","year":"2001","journal-title":"psychol Rev"},{"key":"B43","doi-asserted-by":"publisher","first-page":"jep","DOI":"10.5127\/jep.027512","article-title":"Does anxiety sensitivity cause panic symptoms? An experimental investigation","volume":"4","author":"Dixon","year":"2013","journal-title":"J Exp Psychopathol"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2014.00278","article-title":"From the heart to the mind: Cardiac vagal tone modulates top-down and bottom-up visual perception and attention to emotional stimuli","volume":"5","author":"Park","year":"2014","journal-title":"Front Psychol"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2013.09.001","article-title":"Mechanisms of change in cognitive behavioral therapy for panic disorder: The unique effects of self-efficacy and anxiety sensitivity","volume":"51","author":"Gallagher","year":"2013","journal-title":"Behav Res Ther"},{"key":"B46","volume-title":"Anxiety and its disorders: The nature and treatment of anxiety and panic","author":"Barlow","year":"1988"},{"key":"B47","volume-title":"Anxiety and its disorders: The nature and treatment of anxiety and panic","author":"Barlow","year":"2002"},{"key":"B48","first-page":"1","article-title":"Panic disorder and agoraphobia","volume-title":"Clinical handbook of psychological disorders: A step by step treatment manual","author":"Barlow","year":"2014"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1533019\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T05:22:28Z","timestamp":1748841748000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1533019\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,2]]},"references-count":48,"alternative-id":["10.3389\/fpsyt.2025.1533019"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2025.1533019","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,2]]},"article-number":"1533019"}}