Capnometry-Guided Breathing and PTSD: A Novel Treatment Approach

Abstract

Post-traumatic Stress Disorder (PTSD) is a complex and frequently chronic condition whose primary treatments (exposure-based psychotherapies and anti-depressant medications) fail to benefit a significant number of treated individuals. The burden of the condition is compounded by inadequate access to evidence-based treatments. This report introduces Freespira, a novel prescription digital therapeutic (capnometry-guided respiratory intervention or CGRI) initially developed for treatment of panic disorder and subsequently FDA-cleared for treatment of PTSD. The CGRI intervention provides breath-to-breath feedback of respiratory rate and end tidal CO2 and is aimed at normalizing respiratory physiology while teaching self-management skills that can be applied during exposure to stressors or traumatic reminders/triggers. Real-world outcomes for 208 commercially-insured patients are reported here with PCL-5 scores decreasing by 24 points (48%) from pre- to post-treatment (effect size = 1.10, p < 0.001). About 86% of users had a 10 point reductions on the PCL-5. Adherence rates of 81% are consistent with prior reports. Qualitative review of completed cases suggests that many users develop improved ability to recognize and then normalize respiratory irregularities. These self-management skills appear to inhibit symptom surges, encouraging users to resume previously avoided situations.