ISARP New Brunswick 2014 Program 8

INTERNATIONAL SOCIETY FOR ADVANCEMENT OF RESPIRATORY PSYCHOPHYSIOLOGY ANNUAL MEETING SEPTEMBER 19-21, 2014 Hosted by Rutgers University – Robert Wood Johnson Medical School Department of Psychiatry and Office of Global Health 1 CLINICAL ACADEMIC BUILDING RUTGERS – ROBERT WOOD JOHNSON MEDICAL SCHOOL 125 PATTERSON ST, NEW BRUNSWICK, NJ 08901 2 ISARP New Brunswick 2014 PROGRAM Friday, September 19, 2014 (evening program open to the Rutgers community) 5 – 5:30 PM Registration 5:30 – 6:30 PM Welcome Anthony Scardella Rutgers University – Robert Wood Johnson Medical School New Brunswick, NJ, USA Organizer’s address BREATH, BEATS, AND BEHAVIOR: Applied Psychophysiology, Stress Management, and Behavioral Medicine Paul Lehrer Rutgers University – Robert Wood Johnson Medical School New Brunswick, NJ, USA 6:30-8:30 Reception and registration 3 Saturday, September 20, 2014 8:00 – 8:30 AM Conference Registration (coffee available) 8:30 – 10:00 AM Symposium 1 Psychophysiology of coughing in neurological disease and healthy people Chair: Paul Davenport Co-Chair: Karen Hegland University of Florida, Gainesville, FL, USA The impact of harmfulness information on urge-to-cough Thomas Janssens, Sarah Brepoels, Lieven Dupont, Omer Van den Bergh University of Leuven, Leuven, Belgium The effect of expiratory muscle strength training (EMST) on urge-to-cough in stroke patients Karen W. Hegland1 kwheeler@ufl.edu Michelle S. Troche,1 Floris Singletary, 2 Paul W. Davenport1 1University of Florida 2Brooks Rehabilitation Clinical Research Center Jacksonville, FL, USA Gainesville, FL Deep Brain stimulation and airway protection in Parkinson’s disease Michelle S. Troche michi81@PHHP.UFL.EDU Karen W. Hegland, Alexandra E. Brandimore, Michael Okun, Paul W. Davenport University of Florida, Gainesville, FL, USA Assessment of dystussia in traumatic brain injury Erin Silverman 1,2,3 epearson@ufl.edu Sarah Miller3, Christine Sapienza4, Paul W. DavenportPhD1 1University of Florida, Gainesville, FL 2North Florida South Georgia Veteran’s Health System, Malcom Randall VAMC 3University of Memphis, Memphis, TN, USA 4 Jacksonville University, Jacksonville, FL, USA 4 10:00 – 10:30 AM Coffee/tea/snack break 10:30 – 12:00 PM Symposium 2 Respiratory retraining in asthma Chair: Jonathan Feldman Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA Dysfunctional Breathing- The significance of a multi-dimensional view for breathing re-training in asthma Rosalba Courtney breathandbody@optusnet.com.au Southern Cross University, East Lismore NSW, Australia Heart rate variability biofeedback: its role in asthma therapeutics Paul Lehrer1 lehrer@rwjms.rutgers.edu Frederick Wamboldt,2 Evgeny Vaschillo1, Charles Irvin,3 Shou-En Lu,1 Milisyaris Aviles, 1 Jessica Graves2 1Rutgers --- The State University of NJ, Piscataway, NJ, USA 2National Jewish Health, Denver, CO, USA 3 University of Vermont, Burlington, VT, USA Pilot Study of Hypoventilation Treatment on Anxiety in Patients with Asthma Alicia E. Meuret,1 ameuret@mail.smu.edu David Rosenfield,1 Ashton M. Steele,1 Mark. M. Millard,2 Thomas Ritz,1 1Southern Methodist University, Dallas, Texas, USA 2Baylor University Medical Center, Dallas, Texas, USA Hypoventilation training in asthma: Results from a capnometryassisted breathing training trial Thomas Ritz,1 tritz@mail.smu.edu David Rosenfield,1 Ashton M. Steele,1 Mark. M. Millard,2 Alicia E. Meuret,1 1Southern Methodist University, Dallas, Texas, USA 2Baylor University Medical Center, Dallas, Texas, USA 12:00 – 1:30 PM Lunch 5 1:30 – 2:30 PM Invited Address Chair: Paul Lehrer Rutgers – Robert Wood Johnson Medical School Let's talk about asthma and vocal cord dysfunction Charles Irvin University of Vermont, Burlington, VT, USA 2:30-4:00 PM Poster Session (with coffee) 4:00-5:30 PM Symposium 3: Effects of voluntary breathing maneuvers Chair: Thomas Ritz Southern Methodist University, Dallas, TX, USA The effect of slow diapragmatic breathing on heart beat and event related potentials (HEPs) Richard Gevirtz, rgevirtz@alliant.edu California School of Professional Psychology, Alliant University San Diego, CA, USA Sigh to restore respiratory variability. Proposed mechanism Evgeny Vaschillo evaschil@rci.rutgers.edu Bronya Vaschillo, Jennifer Buckman, Sydney Heiss, Marsha Bates Rutgers University, Piscataway, New Jersey, USA The effect of sighs on self-reported relief and physiological muscle tension. Elke Vlemincx elke.vlemincx@ppw.kuleuven.be Ilse Van Diest, Omer Van den Bergh University of Leuven, Leuven, Belgium Indirect regulation of breathing: a detour may be fastest Jan van Dixhoorn dixhoorn@versatel.nl Centre for breathing Therapy, Amersfoort and Research Center Linnaeus Institute, Haarlem. The Netherlands 6 6:00 PM ISARP Dinner, The Rutgers Club 199 College Avenue, New Brunswick Sunday, September 21, 2014 7-8:15 AM Board meeting 8-8:30 AM Registration 8:15-10:30 AM Symposium 4: Affect and respiratory sensation. Chair: Alicia Meuret, Southern Methodist University, Dallas, TX, USA How is breathlessness remembered by patients with Medically Unexplained Dyspnea? Marta Walentynowicz Marta.Walentynowicz@ppw.kuleuven.be Katleen Bogaerts, Linda Stans, Ilse Van Diest, Filip Raes, Omer Van den Bergh University of Leuven, Leuven, Belgium Neural processing of short-term habituation and sensitization to dyspnea Andreas Von Leupoldt1,2 andreas.vonleupoldt@ppw.kuleuven.be Roland W Esser 2, MMatthias Gamer 2, Christian Büchel2, Maria Cornelia Stoeckel 2 1 2 University of Leuven, Leuven, Belgium University Medical Center Hamburg-Eppendorf, Hamburg, Germany 7 Affective Modulation of respiratory sensory gating: a mechanism for the emotion-related overperception of respiratory sensations? Cecile Chenivesse1,2,3,4, cchenivesse@ufl.edu Pei Ying Chan5, Hsiu-Wen Tsai1, Karen Wheeler-Hegland6, Erin Silverman1, Andreas Von Leupoldt7, Thomas Similowski2,3,4, Paul W Davenport1 1 University of Florida, Gainesville, FL 2 AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France 3 Sorbonne Universités, Paris, France 4 INSERM, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France 5 Chang Gung University, Taiwan 6University of Florida, Gainesville, FL, USA 7 University of Leuven, Leuven Belgium Symptom perception and affect: A theoretical account Omer Van den Bergh, Omer.VandenBergh@ppw.kuleuven.be University of Leuven, Leuven, Belgium Psychological treatment of comorbid asthma and panic disorder in Latino adults: Results from a randomized controlled pilot study Jonathan M. Feldman,PhD1 JFeldman@aecom.yu.edu Lynne Matte,1 Alejandro Interian,2 Paul M. Lehrer,3 Bari Scheckner,1 Dara Steinberg,1 Shou-En Lu,3., Anu Kotay,4 Sumita Sinha,4 Chang Shim5 1Ferkauf Graduate School of Psychology, Yeshiva University 2VA New Jersey Healthcare System 3Rutgers – The State University of New Jersey 4 Montefiore Medical Center/Albert Einstein College of Medicine 5 Jacobi Medical Center/Albert Einstein College of Medicine Management of psychological comorbidities in females with COPD in a rural healthcare setting Sarah Miller1 sarahmilleruf@gmail.com Erin Silverman2, 3, 4, Belinda Fleming 1 1 University of Memphis, Memphis, TN 2 University of Florida, Gainesville, FL 3North Florida South Georgia Veteran’s Health System, Malcom Randall VAMC 4Rehabilitation Outcomes Research Center – Malcom Randall VAMC, Gainesville, FL 10:45 – 11:15 AM 8 Coffee/tea/snack break 11:15 – 12:15 PM Invited Address Chair: Omer Van den Bergh, University of Leuven, Leuven, Belgium Psychological and physiological effects of exposure to inhaled environmental toxins and irritants. Nancy Fiedler nfiedler@eohsi.rutgers.edu Rutgers – The State University of New Jersey, Piscataway, NJ, USA 12:15 – 1:45 PM (Lunch – on your own, please see restaurant list) 1:45 – 3:45 PM Symposium 5: Social influences on asthma Chair: Daphne Koinis-Mitchell, The Warren Alpert Medical School of Brown University, Providence, RI, USA Child Parent Symptom Perception as Predictors of Asthma Illness Representations and Asthma Control Kimberly Arcoleo1 Arcoleo.1@osu.edu Jonathan Feldman2 1The Ohio State University, College of Nursing, Columbus, OH, USA 2 Yeshiva University, Ferkauf Graduate School of Psychology Bronx, NY, USA Cumulative prenatal and early childhood stress associated with poor lung growth and reduced exhaled nitric oxide in school-aged urban children. Yueh-Hsui Mathilda Chiu1 (Rosalind J. Wright) rosalind.wright@mssm.edu Wayne Morgan,2 Thomas Ritz,3 Brent A. Coull,4 Robert O. Wright,1 Rosalind Wright1 1Icahn School of Medicine at Mount Sinai, New York, NY 2University of Arizona, Tuscon, AZ 3Southern Methodist Univesity, Dallas, TX 4Harvard School of Public Health, Boston, MA 9 Psychiatric symptoms, bronchodilator response, and symptom magnification in Latino children with asthma Elizabeth L. McQuaid1. elizabeth_mcquaid@brown.edu Nicole R. Nugent,1., Daphne Koinis-Mitchell,1., Ronald Seifer, 1., Glorisa Canino, 2., Gregory K. Fritz1 1Bradley/Hasbro Children’s Research Center, Alpert Medical School Brown University, Providence, RI, USA 2Behavioral Sciences Research Institute, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA Immediate Efficacy of a School-based Intervention for Urban Adolescents with Undiagnosed Asthma: A Randomized Control Trial Bruzzese, Jean-Marie Jean-Marie Bruzzese1 Jean-Marie.Bruzzese@nyumc.org Amarilis Cespedes1, Sharon Kingston2, Beverley J. Sheares3, Zhe Su1, Hossein Sadeghi3, Meyer Kattan3, David Evans3 1NYU School of Medicine, New York, NY 2Dickinson College, Carlisle, PA 3Columbia University College of Physicians and Surgeons, New York, NY Rhinitis Symptoms and Asthma Control in Urban Children with Asthma and Allergic Rhinitis Robin S. Everhart1 Sheryl J. Kopel,2 Cynthia A. Esteban,2 Elizabeth L. McQuaid,2 Greg Fritz,2 Robert Klein,2 Daphne Koinis-Mitchell2 1 Virginia Commonwealth University, Department of Psychology, Richmond, VA USA, 2 Bradley/Hasbro Children’s Research Center, Alpert Medical School, Brown University, Providence, RI USA 3:45 – 4:14 PM Coffee/tea/snack break 10 4:15 – 5:15 PM Presidential Address Asthma and sleep in an urban context: research, education, and intervention Daphne Koinis-Mitchell The Warren Alpert Medical School of Brown University, Providence, RI, USA 5:15 – 5:45 PM Student Awards and business meeting Preview of ISARP 2015 ISARP Business Meeting 11 ISARP 2014 Poster Session Posters should be put up as soon after registration as possible, and left up for the entire meeting. It will be desirable for poster presenters to be near their posters for periods of time during session breaks, and should leave contact information near the poster for those interested in discussing it. B4 Aviles-Velez avilesmi@rwjms.rutgers.edu Effect of Heart Rate Variability Biofeedback on Methacholine Airway Reactivity in a Sample of Steroid Naïve Asthma Patients Milisyaris Aviles-Velez,1 Jessica Graves,2 Charles Irvin,3 Frederick Wamboldt2 Shou-En Lu, Paul Lehrer1 A1 Brandimore aessman@ufl.edu Respiratory kinematics of reflex and voluntary cough in healthy adults Alexandra E. Brandimore, Michelle S. Troche, Paul W. Davenport, Karen W. Hegland University of Florida, Gainesville, FL, USA B1 Chiu cornelchiu@yahoo.com Autonomic effects of heart rate variability in a study of patients with mild and moderate asthma Cornel Chiu,1 Evgeny Vaschillo, 1 Milisyaris Aviles,1 Shireen Hamza, 1 Maria Katsamanis, 1 Frederick Wamboldt, 2 Jessica Graves, 2 Shou-En Lu,1 Paul Lehrer1 1Rutgers – The State University of New Jersey, Piscataway, NJ, USA 2National Jewish Health, Denver, CO, USA A3 Cox pcox1@hmc.psu.edu Sensory distraction via cutaneous stimulation reduces dyspnea in COPD patients. Phillip Cox DO, Ben Bartsch, Philippe Haouzi Penn State Hershey Medical Center, Division of Pulmonary and Critical Care Medicine 12 B9 Eddie Heart Rate Variability Biofeedback to Reduce daveddie@scarletmail.rutgers.edu Craving During Treatment for Substance Use Disorders David Eddie, 1 Chrys Kim, 1 Paul Lehrer, 1 Erin Deneke,2 Marsha E. Bates1 1Rutgers – The State University of New Jersey, Piscataway, NJ, USA 2 Caron Treatment Centers, Wernersville PA, USA D5 Grinberg alice.grinberg@gmail.com A4 Guardiola jerry.yu@louisville.edu Activation of chemosensors in the lung stimulates breathing Juan Guardiola. Jerry Yu Robely Rex VA Medical Center and University of Louisville, Louisville, KY, USA C1 Leyro Nicotine withdrawal severity moderates the relation between panic disorder status and physiological stress reactivity Teresa M. Leyro 1 Michael J. Zvolensky 2 1 Rutgers – The State University of New Jersey, Piscataway, NJ, USA 2 University of Houston, Houston, TX, USA teresa.leyro@rutgers.edu D1 Oken okentt@gmail.com Respiratory disease and executive functioning among adults in the United States Alice Grinberg,1 Renee Goodwin 1, 21 Department of Psychology, City University of New York (CUNY), Flushing, NY USA 2 Department of Epidemiology, Mailman School of Public Health, New York, NY, USA The relationship between heart rate variability, depression, and anxiety: baseline findings from a randomized controlled trial of a panic disorder intervention for Latino adults with asthma Tanya Oken1, Jonathan M. Feldman1 and Paul Lehrer2 1Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA 2Rutgers – The State University of New Jersey, Piscataway, NJ, USA 13 B2 Maulion pdm62@scarletmail.rutgers.edu Effects of Heart Rate Variability Biofeedback on Airway Inflammation Patrick Maulion1, Milisyaris Aviles1, Jessica Graves2, Frederick Wamboldt2, Shou-En Lu,1 Paul Lehrer1 1Rutgers – The State University of New Jersey, Piscataway, NJ, USA 2National Jewish Health, Denver, CO D4 Raveensdran esperanza.morales@nyu.edu The Relationship between Acculturation, Asthma Psychological Triggers, and Utilization of Quick Relief Medication in Mexican and Puerto Rican Families Esperanza Morales Raveendran1, Kimberly Arcoleo2, MPH, Jonathan Feldman1 1Ferkauf Graduate School of Psychology Yeshiva University; New York, USA 2 Ohio State University College of Nursing, Columbus, OH, USA B7 Ritz tritz@mail.smu.edu Correcting respiratory sinus arrhythmia for respiratory influences: Findings with an infant stress paradigm Thomas Ritz1, Michelle Bosquet Enlow2, Lucy King2, Hannah Schreier3, Kelly Brunst3, Stefan M. Schulz4, Rosalind J. Wright4 1 Southern Methodist University, Dallas, TX, USA 2 Boston Children's Hospital and Harvard Medical School, Boston, MA, USA 3 Icahn School of Medicine at Mount Sinai, New York, NY, USA 4 University of Wuerzburg, Wuerzburg, Germany D2 Sandler jonmsandler@gmail.com Asthma-Related Death of a Loved One, Panic Disorder, and Ataque de Nervios in Latino Adults with Asthma Jonathan M. Sandler, Jonathan M. Feldman Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA 14 D3 C2 Scheckner The Effect of Parental Social Support and Bari.Scheckner@psych.ferkauf.yu.e Acculturation on Childhood Asthma Control du Bari Scheckner,1 Kimberly Arcoleo, PhD3, Jonathan M. FeldmanPhD1,2 1Ferkauf Graduate School of Psychology, Yeshiva University, NY 2Department of Epidemiology and Population Health, Albert Einstein College of Medicine, NY 3Ohio State University College of Nursing, OH Schroijen Mathias.Schroijen@ppw.kuleuven. be Assessing differential effects of fear and anxiety to respiratory threat. Mathias Schroijen1, Simona Fantoni1, Carmen Rivera1, Bram Vervliet1, Koen Schruers12, Omer Van den Bergh1 Ilse Van Diest1 1KU Leuven - University of Leuven, Leuven Belgium. 2Maastricht University, the Netherlands. Singer spaceman792@live.com Effects of heart rate variability biofeedback on asthma symptoms Michael Singer,1 Gabriel Pontipiedra,1 Kevin Ma,1 Nimesh Patel,1 Patrick Maulion,1 Milisyaris Aviles,1 Jessica Graves, 2 Frederick Wamboldt,2 Shou-En Lu,1 Paul M Lehrer1 1Rutgers—The State University of New Jersey, Piscataway, NJ,USA 2National Jewish Health, Denver, CO, USA C3 Van Den Houte Maaike.VanDenHoute@ppw.kuleu ven.be Low end-tidal PCO2 across stress-related disorders: A transdiagnostic exploration of its correlates Maaike Van Den Houte, Katleen Bogaerts, Lukas Van Oudenhove, Ilse Van Diest Omer Van den Bergh University of Leuven, Leuven, Belgium B5 van Dixhoorn dixhoorn@versatel.nl Psychophysiological treatment of anxiety: does the diagnosis matter? Jan van Dixhoorn Centre for breathing Therapy, Amersfoort and Research Center Linnaeus Institute, Haarlem. The B3 15 Netherlands B6 Vaschillo evaschil@rci.rutgers.edu Resonance breathing affects hemodynamic oscillations in the brain at 0.1 Hz Evgeny Vaschillo,1 Jennifer F Buckman,1 Deena Peyser 1 Sydney Heiss,1 Peter Barnas,1 Laura Banu, 1 Alexander Puhalla, 1 Bronya Vaschillo,1 David Eddie,1 Suchismita Ray,1 Stephen Hanson,2 Catherine Hanson,2 Bharat Biswal,3 Marsha E Bates1 1Rutgers – The State University of New Jersey, Piscataway, NJ, USA 2Rutgers – The State University of New Jersey, Newark, NJ, USA 3New Jersey Institute of Technology, Newark, NJ, USA C6 Vazquez Asthma triggers in Latino adults with comorbid asthma and panic disorder kvazquez427@gmail.com Karinna Vazquez, Jonathan Feldman Yeshiva University, Ferkauf Graduate School of Psychology, Bronx, NY, USA C4 Walentynowicz Marta.Walentynowicz@ppw.kuleu ven.be Retrospective memory for breathlessness and pain. Marta Walentynowicz,1 Ilse Van Diest,1 Filip Raes,2 Omer Van den Bergh1 1Health Psychology, 2 Learning and Experimental Psychopathology, University of Leuven, Leuven, Belgium C5 Wuyts ruth.wuyts@ppw.kuleuven.be The influence of respiratory dynamics on relaxation and cardiorespiratory parameters and the response to and recovery from mental stress. Ruth Wuyts, Elke Vlemincx, Ilse Van Diest, Omer Van den Bergh University of Leuven, Leuven, Belgium 16 ABSTRACTS (alphabetical order) Child & parent symptom perception as predictors of asthma illness representations and asthma control Kimberly Arcoleo, PhD1 Arcoleo.1@osu.edu Jonathan Feldman, PhD2 1 2 The Ohio State University, College of Nursing, Columbus, OH, USA Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA Background: Asthma remains a major public health problem despite advances in pharmacologic management of the disease. Recognition of asthma symptoms and early warning signs is dependent upon subjective perceptions of children and parents. Failure to detect asthma symptoms is associated with poor asthma control. What is not known is how children’s and parents’ symptom perception influences their asthma illness representations which are predictive of asthma control. Methods: 1 year longitudinal study of 300 Mexican & Puerto Rican mothers & 300 children ages 5–12 w/asthma recruited from 2 school-based health centers & Breathmobile in Phoenix, AZ & 1 pediatric asthma & allergy clinic in Bronx, NY. Interviews & child PFTs @ baseline and 3, 6, 9, & 12 months; medical record reviews @ 12 months. Results. Results from N=267 baseline interviews. SEM examined effects of sociodemographic characteristics, parental depression, child and parent symptom perception, and asthma illness representation on clinician rated asthma control by ethnicity. Results: The data fit the model well (RMSEA=.02, CFI=.97, TLI=.93, Χ2=.39) and accounted for 22% of the variance in AIRS scores and 9% in asthma control. Parents reporting higher depressive symptoms, living in poverty, lower education, and higher panic and irritability had AIRS scores aligned with the lay model. There was no effect for children’s symptom perception. AIRS scores congruent with the lay model and Puerto Rican ethnicity were associated with poor asthma control. There was an indirect effect of parents’ education through AIRS on asthma control. Discussion: A window of opportunity exists when asthma patients can use bronchodilator medications to prevent asthma exacerbations and maintain good control. Parents who have elevated depressive symptoms, panic, and irritability may delay administration of medications resulting in adverse health outcomes for their children. Interventions targeting medication adherence need to assess and treat caregiver psychiatric disorders to achieve optimal outcomes. 17 Effect of Heart Rate Variability Biofeedback on Methacholine Airway Reactivity in a Sample of Steroid Naïve Asthma Patients Milisyaris Aviles-Velez, MS1 avilesmi@rwjms.rutgers.edu Jessica Graves, MA2 Charles Irvin, PhD3 Frederick Wamboldt, MD2 Shou-En Lu, PhD4 Paul Lehrer, PhD1 1 Department of Psychiatry, Rutgers -- Robert Wood Johnson Medical School, Piscataway, NJ, USA Jewish Health, Denver, CO, USA 3 University of Vermont, Burlington, VT, USA 4 Rutgers – School of Public Health, Piscataway, NJ, USA 2 National Background: Asthma is a global health problem affecting around 300 million individuals of all ages, ethnic groups and countries. It is estimated that by 2025 the number of people living with asthma will increase by 100 million, becoming a global health priority. There is an imperative need to investigate effective innovative, effective and low cost treatments to manage this condition. The present study investigates the effects of HRV Biofeedback and EEG music and relaxation on airways hyperesponsiveness-one of the characteristic features of asthma. Method: This is an interim analysis of an ongoing two-center trial. The patients received 4 visits of screening and asthma education where pulmonary function was assessed. Participants who met the inclusion criteria were given a methacholine challenge test. Participants who had FEV1 PC 20 < 8 mg/ml of methacholine were randomized to either HRV biofeedback or EEG music and relaxation training. The participants trained for 8 visits as well as at home using a StressEreaser or an identical placebo unit for 40 minutes per day. At the final visit the patients had a posttest(what test?) methacholine challenge. Results: Data from 39 patients was used in the final analysis. Using a matched T-test, the HRV biofeedback group showed a significant decrease in airways hyperresponsiveness t(16) = 2.50, p =.0236. The EEG + music + Paced Breathing Group did not show significant changes t(21) = -.81, p =.4283. A sign rank test also yeilded positive results for the group receiving HRV biofeedback with a unidirectional hypothesis; one sided, p =.0279. Discussion: Airway hyper-reactivity in asthmatics has previously been shown to be associated with abnormal autonomic nervous system (ANS) control. In particular, the parasympathetic (vagal) component of the ANS appears to be implicated in the pathogenesis of asthma. Methacholine is a drug that will affect the parasympathetic control. The current results suggest that the HRV biofeedback may impact the regulatory systems of the ANS mediated by the vagal nerve that control airway function. Moreover we suggest that HRV biofeedback may provide an effective, non drug and low cost therapy for asthma that patients seek. 18 Respiratory kinematics of reflex and voluntary cough in healthy adults Alexandra E. Brandimore, MA/CCC-SLP1,2 aessman@ufl.edu Michelle S. Troche, PhD/CCC-SLP, 2 Paul W. Davenport, PhD,3 Karen W. Hegland, PhD/CCC-SLP 1 1Department of Speech, Language, & Hearing Sciences, University of Florida, Gainesville, FL, USA Brain Rehabilitation Research Center, Malcom Randall VA, Gainesville, Florida, USA 3 Department of Physiological Sciences, University of Florida, Gainesville, Florida, USA 2 Background: Voluntary cough (VC), or cough initiated on command, is dependent upon cortically mediated mechanisms (e.g. cognitive functioning, intention). In contrast, reflex cough (RC) is a brainstem-mediated sensorimotor response to a stimulus (i.e. penetrant/aspirant in the airway), that is modified cortically, or volitionally in the awake human. There is evidence to suggest that physiological differences exist between the RC and VC; however, the mechanistic and airflow differences between the cough types are not fully understood. Therefore, the aims of this study were to determine the lung volume, respiratory kinematic and airflow differences between RC and VC in healthy young adults. Methods: Twenty-five participants (14 female; 18-29 years) were recruited for this study. Participants were evaluated using respiratory inductance plethysmography calibrated with spirometry. Experimental procedures included: 1) respiratory calibration (rest breathing, vital capacity maneuvers, and isovolume maneuvers), 2) three sequential voluntary cough trials, and 3) three reflex cough trials induced with 200 µM capsaicin. Repeated measures ANOVA and linear regression were used to evaluate the differences between RC and VC. Results: Lung volume initiation (LVI; p=.003) and lung volume excursion (LVE; p<.001) were significantly greater for VC compared to RC. The rib cage and abdomen significantly influenced LVI for VC (p<.001); however, only the rib cage significantly impacted LVI for RC (p<.001). LVI significantly influenced peak expiratory flow rate for VC (p=.029), but not RC (p=.610). Discussion: Production of a RC results in significant lung volume, respiratory kinematic and airflow differences compared to VC. These findings likely reflect the influence of a perceived urge-to-cough prior to RC whereby detection of the sensory stimulus modifies motor aspects of the reflexive behavior. Further understanding of the urge-to-cough and the differences between RC and VC in older adults and in persons with dystussia (cough dysfunction) will be essential to facilitate the development of successful cough treatment paradigms. 19 Immediate efficacy of a school-based intervention for urban adolescents with undiagnosed asthma: a randomized control trial Jean-Marie Bruzzese, PhD1 Jean-Marie.Bruzzese@nyumc.org Amarilis Cespedes, MPH,1 Sharon Kingston, PhD,2 Beverley J. Sheares, MD, MS,3 Zhe Su, MS,1 Hossein Sadeghi, MD,3 Meyer Kattan, MD,3 David Evans, PhD3 1NYU School of Medicine, New York, NY, USA College, Carlisle, PA, USA 3Columbia University College of Physicians and Surgeons, New York, NY, USA 2Dickinson Background: Undiagnosed asthma has high prevalence and morbidity in adolescents. No intervention has specifically targeted undiagnosed adolescents. This study tests the immediate efficacy of Asthma SelfManagement for Adolescents with Undiagnosed Asthma (ASMA-Undx), a school-based intervention to help adolescents obtain a clinical evaluation and diagnosis, and manage their symptoms. Methods: 399 urban, predominately Hispanic and African American adolescents with symptoms of moderate to severe persistent asthma, but no diagnosis, were randomized to ASMA-Undx or a control condition. ASMA-Undx consists of (1) an 8-week intervention delivered to students, which includes referral to their medical providers and group and individual coaching sessions to learn how to care for asthma; (2) an intervention for the students’ caregivers delivered via mail and phone to help them support their child’s efforts; and (3) education for students’ medical providers via academic detailing. Primary outcomes were the proportion of students who: saw a medical provider for an evaluation; were diagnosed with asthma; and were prescribed medication. Secondary outcomes were steps taken to prevent and to manage symptoms, and self-efficacy to care for asthma. Treatment groups were compared using Generalized Linear Mixed Effects Models. Intent-to-treat analyses controlled for baseline outcome values and asthma severity, and included random effects for schools. Results: Relative to controls, ASMA-Undx students had significantly (P<.0001) higher odds of obtaining a clinical evaluation (OR=5.00), of being diagnosed with asthma (OR=8.03), and of obtaining asthma medication (OR=5.71). They had higher rates of taking steps to prevent symptoms (RR=1.19, P<.01) and more confidence to care for asthma (RR=0.58, P<.0001). Discussion: ASMA-Undx, the first intervention designed specifically for adolescents with undiagnosed asthma, results in improvements in rates of adolescents who obtain a clinical evaluation and a diagnosis, and improvements in asthma self-management. Future studies should consider the long-term impact of ASMA-Undx on asthma control and urgent health care utilization. 20 Affective modulation of respiratory sensory gating: a mechanism for the emotionrelated overperception of respiratory sensations? Cecile Chenivesse, MD, PhD1,2,3,4, cecile.chenivesse@psl.aphp.fr Pei Ying Chan, PhD,5 Hsiu-Wen Tsai, PhD,1 Karen Wheeler-Hegland, PhD/CCC-SLP, 6 Erin Silverman, PhD,1 Andreas Von Leupoldt, PhD,7 Thomas Similowski, MD, PhD,2,3,4 Paul W Davenport, PhD1 1 Department of Physiological Sciences, University of Florida, Gainesville, FL 32610, USA Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale, 47-83 boulevard de l’hôpital, F-75013, Paris, France 3 Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France 4 INSERM, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France 5 Department of Occupational Therapy, Chang Gung University, Taiwan 6 Department of Speech Language and Hearing Sciences, University of Florida, Gainesville, FL 32610, USA 7 Research group on Health Psychology, University of Leuven, Belgium 2 AP-HP, Background. Some patients are symptom overperceivers because they perceive respiratory sensations with a higher intensity than expected for the magnitude of the stimulus. Clinical observations suggest that psychological factors might cause an increase in respiratory sensory perception. The cortical neural modulation of respiratory sensory processing by emotion is poorly understood. We hypothesize that emotion-related respiratory overperception may be due to a decrease in the respiratory-related evoked potentials (RREP) sensory gating (RSG). Methods. The RSG was compared between negative and neutral emotional conditions in healthy subjects. Emotions were modulated by IAPS pictures. The RSG was assessed by the RREP elicited by paired inspiratory occlusions. The RSG was calculated as the difference between the second (S2) and first (S1) occlusions RREP N1 peak amplitude. Results. Six males and seven females (34 years [23;46]) were studied. Negative pictures were rated with a lower valence and a higher arousal than neutral pictures (p=0.001). Viewing negative pictures decreased the RREP N1 amplitude elicited by the S1 (Negative N1 = -3.37 µV [-4.62;-1.37] versus Neutral N1 = -4.59 µV [-6.08;-1.36]; p=0.017). The RREP N1 amplitudes produced by the S2 were not significantly different between Negative and Neutral. The N1 amplitude difference between S1 and S2 was significantly reduced in the Negative condition (Negative = 3.73 µV [0;5.82] versus Neutral = 4.79 µV [3;6.20]; p=0.038). Discussion. The reduction in the RREP N1 amplitude elicited by the S1 occlusion while viewing negative pictures is likely related to a shift of subject’s attention toward the emotional stimulus to the detriment of the respiratory sensory inputs. Thus, negative pictures produced a decrease in the RREP measure of RSG. These results suggest that negative emotions may increase respiratory sensory information activating the cortex by reduced RSG and may be associated with an overperception of respiratory stimuli. 21 Autonomic effects of heart rate variability in a study of patients with mild and moderate asthma Cornel Chiu1 cornelchiu@yahoo.com Evgeny Vaschillo, PhD 1 Milisyaris Aviles, MS 1 Shireen Hamza, 1 Maria Katsamanis, PsyD 1 Frederick Wamboldt, MD 2 Jessica Graves, MA, 2 Shou-En Lu, PhD,1 Paul Lehrer, PhD1 1Rutgers – The State University of New Jersey, Piscataway, NJ, USA Jewish Health, Denver, CO, USA 2National Background. Heart rate variability biofeedback (HRV-BF) has previously been found efficacious for treating asthma. In this preliminary analysis on data from steroid-naïve adult asthma patients from a twocenter clinical trial with steroid naïve adult subjects, we examined autonomic effects of HRV-BF compared with a control condition comprising training to increase EEG alpha, listening to relaxing music, and breathing at a relaxed rate (about 15 breaths/min). Methods. Subjects were randomly divided into two groups: HRV-BF and a combination of EEG biofeedback, paced breathing at a comfortable rate between 10-12 breaths per minute, and listening to relaxing music. They received 6-10 sessions of training over a three-month period, with assigned daily practice. Physiological data weres collected each session during three visitsspaced evenly during the trial. In each session, physiological data were recorded during a five minute baseline (plain vanilla task), followed by five minutes of,intervention (HRV-BF or EEG biofeedback plus breathing at a relaxed rate) and then another 5-min baseline. Results. Forty-seven participants in began the trial. In later sessions there were a decreased number of participants because some had not yet completed the study. This discrepancy was taken into account to prevent it from influencing the analysis. We analyzed heart rate, pulse transit time, respiration frequency, and pulse amplitude, as well as oscillations in these measures in the high frequency (HF) (0.15-0.4 Hz), low frequency (LF) (0.05-0.15 Hz), and very low frequency (VLF) (0.005-0.15 Hz) ranges. HRV biofeedback patients slowed their breathing during paced breathing periods to about 6 times a minute, with large increases in LF and total HRV, while patients in the relaxed breathing condition breathed about 15 times a minute, with little change in HRV measures. Pulse transit time variability increased in the HRV BF group, particularly in the VLF range, andboth mean and variability of pulse amplitude decreased. Discussion. Participants adhered to the directions and performed HRV biofeedback correctly. Changes in pulse transit time and pulse amplitude suggested that the HRV-BF procedure stimulates the alpha sympathetic system, and the sympathetically-mediated vascular tone branch of the baroreflex system. There is some evidence that the alpha sympathetic system may play a role in asthma, particularly exercise-induced asthma. Further analysis and study is needed to determine whether these changes mediate biofeedback-induced therapeutic changes in asthma. 22 Cumulative prenatal and early childhood stress associated with poor lung growth and reduced exhaled nitric oxide in school-aged urban children. Yueh-Hsui Mathilda Chiu1 (Rosalind J. Wright) rosalind.wright@mssm.edu Wayne Morgan,2 Thomas Ritz, PhD,3 BA Coull 4, Robert O. Wright, 1 Rosalind J. Wright, MD MPH1 1Icahn School of Medicine at Mount Sinai, New York, NY of Arizona, Tuscon, AZ 3Southern Methodist Univesity, Dallas, TX 2University Background. An important step toward identifying children at risk for chronic respiratory disorders is characterizing mechanisms that lead to and maintain early predisposition. Method We indexed pre- and postnatal maternal stress by a negative life events (NLEs) score (range 0-9) assessed prenatally, in the first 2 years of the child’s life (early postnatal) and at lung function testing (7.0 ± 0.9 years) (late postnatal) in the Asthma Coalition on Community, Environment, and Social Stress (ACCESS) Project. Outcomes were diagnosed asthma and forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and the FEV1/FVC ratio as well as exhaled nitric oxide (eNO), a measure of eosinophilic airway inflammation. We considered pre- and/or postnatal NLEs separately and concurrently (all moderately correlated, r<0.5, p=0.01), by collapsing scores into low (0-2, <median) and high (≥3, >median) groups and categorizing as low pre/low postnatal, high pre/low postnatal, low pre/high postnatal, and high pre/high postnatal stress. Results. Mothers with higher NLEs in both the pre- and early postnatal periods were most likely to have children with asthma (n=502). Children of mothers with high NLEs in both pre- and early postnatal periods had decreased FEV1 and FVC with a preserved ratio (n=150). Children born to mothers reporting high NLEs across all 3 periods had lower eNO levels at the 7 year follow-up compared to children whose mothers reported low NLEs across all three periods. Discussion. These data suggest that reduced lung function in relation to early life stress may be due to compromised lung growth starting in utero and that oxidative stress and non-eosinophilic inflammation may have a central role. 23 Dysfunctional breathing- the significance of a multi-dimensional view for breathing retraining in asthma Rosalba Courtney, DO breathandbody@optusnet.com.au Southern Cross University, East Lismore NSW, Australia Background. A growing number of studies suggest that various breathing retraining programs may be helpful in asthma. The main therapeutic rational for most of these programs is the correction of dysfunctional breathing (DB). DB has been reported in 29-64% of asthma sufferers and it is thought to contribute to symptoms and interfere with asthma treatment, however its definition is vague. It is still unclear which patients or which types of breathing dysfunction respond best to particular breathing exercise or retraining regimes. One definition of dysfunctional breathing proposes that it might be viewed practically as a multi-dimensional entity with 3 key dimensions, biochemical, biomechanical and psychopsychological. This review looks at evidence for the importance of each of these dimensions of breathing dysfunction for breathing retraining protocols for asthma. Methods. Data bases Medline, Scopus Proquest, Cinhahl and the Cochran Library were searches for articles discussing dysfunctional breathing, breathing therapy, breathing training and asthma. Additional relevant articles were sourced from reference lists of articles retrieved through database searches. Results. There is evidence for the importance of biochemical, biomechanical and psychophysiological dimensions of dysfunctional breathing in asthma. Aggravation of asthma symptoms can occur due to hyperventilation, inefficient and aberrant breathing patterns associated with neuromuscular factors such as muscle tension and hyperinflation, conditioned breathing behaviors and a patient’s sense of the congruence of their symptoms and perceived control. Breathing retraining protocols may impact on all these factors. However, it appears that improvements in these parameters and overall improvement in asthma is more likely to occur when they are specifically measured and targeted. Discussion. Breathing retraining for asthma is more likely to be successful when it is targeted, individualized, comprehensive and sufficiently intensive to produce measurable improvements in related but also separate dimensions. Ideal breathing therapy should address hyperventilation, breathing behaviors and psychophysiological factors. 24 Sensory Distraction via Cutaneous Stimulation Reduces Dyspnea in COPD Patients. Phillip Cox, DO, pcox1@hmc.psu.edu Ben Bartsch, MD, Philippe Haouzi, MD PhD Penn State Hershey Medical Center, Division of Pulmonary and Critical Care Medicine Rationale: We have recently reported that transcutaneous electrical neural stimulation (TENS) of the C3C5 dermatome alleviates the sensation of dyspnea in a patient with intractable dyspnea following a herpes zoster eruption affecting the cervical dorsal roots. We postulated that the remarkable benefit of this stimulation was to be accounted for by the specific blockade of unmyelinated fibers originating from the diaphragm and/or more likely from unspecific “sensory” distraction, a phenomenon already described with auditory or visual inputs. We sought to determine whether this unspecific “sensory” distraction patients with chronic obstructive disease. Methods: 23 Patients (18-83 years old, FEV1/FVC<70% predicted with FEV1 = 50.45±20.00%) performed 2 six-minute walk tests, separated by a 10-minute resting period. Heart rate, SpO2, and perceived level of dyspnea were recorded every 30 second intervals using a modified Borg Index (0-10). Patients were randomly assigned into one of three groups: control group (C), neck stimulation (N) or back stimulation (B). During the first six-minute walk test no intervention was applied; during the second test, a TENS unit was used to deliver via cutaneous electrodes the following stimulation (frequency of 80 Hz and pulse width 50 microseconds) in the N and B groups, while the C group walked with no stimulation. Results: In contrast to the C group, there was a significant decrease in mean Borg score in the second bout of exercise in the 2 groups B+N (4.63 ±1.62 vs. 3.44 ±1.61, p<0.005). There was no influence of the site of stimulation (B vs. N). 10 BORG SCALE 8 6 4 2 W Walk 1 W 2 1 0 Walk 2 Figure 1: Walk 1 without the TENS. Walk 2 with the TENS activated. BORG scale 0-10 (0 meaning no dyspnea while 10 meaning maximum dyspnea.) Conclusions: It is concluded that cutaneous stimulation involving large myelinated fibers significantly reduces the level of dyspnea in patients with obstructive lung disease regardless of the region stimulated. 25 Heart rate variability biofeedback to reduce craving during treatment for substance use disorders David Eddie, MS daveddie@scarletmail.rutgers.edu [daveddie@scarletmail.rutgers.edu] Chrys Kim, PsyD, Paul Lehrer, PhD, Erin Deneke, PhD., Marsha E. Bates, PhD Rutgers – The State University of New Jersey, Piscataway, NJ, USA Objectives: The present pilot study investigated the implementation feasibility, and efficacy for reducing alcohol and drug craving, of a brief, 3-session heart rate variability biofeedback (HRV BFB) intervention added to a traditional 28-day alcohol and drug use disorder inpatient treatment program. Methods: Forty-eight young adult men received either treatment as usual (TAU) plus three sessions of HRV BFB training over three weeks, or TAU only. Participants receiving HRV BFB training were instructed to practice daily using a hand-held HRV BFB device. Results: HRV BFB training was well tolerated by participants and supported by treatment staff. Participants receiving TAU + HRV BFB demonstrated a greater, medium effect size reduction in alcohol and drug craving compared to those receiving TAU only, although this difference did not reach statistical significance. Hierarchical regression analyses of residual craving change scores yielded significant group by HRV interaction effects wherein baseline levels of HRV were predictive of changes in craving only in the TAU group: Lower baseline levels of HRV were associated with increases in craving from start to end of treatment, whereas higher baseline HRV levels were associated with greater decreases in craving by the end of treatment. In the TAU + HRV BFB group, however, there was no such association. That is, HRV BFB appeared to dissociate individual differences in baseline HRV levels from changes in craving. Conclusions and Implications: Given that alcohol and drug craving often precipitate relapse, HRV BFB merits further study as an adjunct treatment to ameliorate craving experienced by persons with alcohol and drug use disorders. 26 Rhinitis symptoms and asthma control in urban children with asthma and allergic rhinitis Robin S. Everhart, PhD,1 reverhart@vcu.edu Sheryl J. Kopel, MSc,2 Cynthia A. Esteban, MSN, MPH, 2 Elizabeth L. McQuaid, PhD,2 Gregory Fritz, MD,2 Robert Klein, MD,2 & Daphne Koinis-Mitchell, PhD2 1 Virginia Commonwealth University, Department of Psychology, Richmond, VA USA, Children’s Research Center, Alpert Medical School, Brown University, Providence, RI USA 2 Bradley/Hasbro Background: Asthma and allergic rhinitis (AR) are common, comorbid conditions in children. Rhinitis symptoms have the potential to exacerbate asthma in children and interfere with children’s daily functioning. Limited research has considered the effect of rhinitis symptoms on asthma control among urban children with asthma and AR from diverse backgrounds. Methods: Study participants included 227 children with asthma and AR (ages 7 to 9) and their caregivers from African American (32% of families), Latino (51%), and non-Latino white (NLW; 17%) backgrounds. Caregivers and children completed interview-based assessments and a clinician evaluation, as well as three, 4-week periods of daily monitoring to track asthma and rhinitis symptoms across one academic year. Results: The mean proportion of days with rhinitis symptoms was higher in children with poorly controlled asthma (Asthma Control Test scores ≤ 19) as compared to children with well controlled asthma (t(225)=2.49, p=.014). Within groups, days with rhinitis symptoms differed across asthma control in African American children (t(74)=2.29, p=.025); African American children with poorly controlled asthma had higher symptom days (M=.31, SD=.24) as compared to children with well controlled asthma (M=.20 days, SD=.19). Level of asthma control also differed in children of the sample based on their level of rhinitis symptoms. Children above the mean number of rhinitis symptom days had a lower level of asthma control (M=19.34, SD=4.28) than children with fewer rhinitis symptoms (M=20.36, SD=2.54; t(225)=2.45, p=.015). Discussion: Findings suggest that rhinitis symptoms may worsen asthma control among urban children with both asthma and AR. In particular, African American children with poorly controlled asthma in this sample experienced increased rhinitis symptoms. Clinicians may wish to highlight the importance of treating rhinitis symptoms in conjunction with asthma during recommendations to urban caregivers of children with both asthma and AR. 27 Psychological treatment of comorbid asthma and panic disorder in Latino adults: Results from a randomized controlled pilot study Jonathan M. Feldman, PhD1 JFeldman@aecom.yu.edu Lynne Matte, PhD,1 Alejandro Interian, Ph.D,2 Paul M. Lehrer, Ph.D,3 Bari Scheckner, MA,1 Dara Steinberg, PhD,1 Shou-En Lu, Ph.D,4 Anu Kotay, PhD,5 Sumita Sinha, MD,5 Chang Shim, MD6 1Ferkauf Graduate School of Psychology, Yeshiva University 2VA New Jersey Healthcare System 3Rutgers Robert Wood Johnson Medical School University 4Rutgers -Environmental and Occupational Health Sciences Institute 5 Montefiore Medical Center/Albert Einstein College of Medicine 6 Jacobi Medical Center/Albert Einstein College of Medicine Background: Confusion between panic and asthma symptoms can result in serious errors in selfmanagement of both disorders. An intervention was designed with the following elements: differentiation between panic and asthma symptoms, cognitive behavioral therapy (CBT) for panic disorder (PD), asthma education, and heart rate variability biofeedback. This treatment was culturally adapted for Latino participants. The purpose of this study was to examine the preliminary efficacy of this intervention compared with music and relaxation therapy (MRT), which included paced breathing at resting respiration rates. Methods: The sample consisted of 53 Latino adults with asthma and PD between the ages of 19 to 68 years old (M = 43.4 ± 12.9). Puerto Rican participants comprised the main ethnic group (81.1%). Participants were recruited from outpatient clinics at hospitals in the Bronx, NY. PD was assessed with the Structured Clinical Interview for DSM-IV. Participants were randomly assigned to either the CBT or MRT group for 8 weekly sessions. The Panic Disorder Severity Scale (PDSS), the Clinical Global Impression (CGI), and the Asthma Control Questionnaire (ACQ) were administered by an interviewer, who was blind to treatment condition. Results: Approximately half of the participants in both the CBT (n = 16) and MRT (n = 16) groups were treatment responders on the CGI at 3 month follow-up (CBT = 56.2%, MRT = 50.0%). Participants showed improvements on the PDSS from baseline (CBT = 2.2, MRT = 2.4) to 3-month follow-up (CBT = 1.3, MRT = 1.5) and the ACQ (CBT and MRT = 25% increase in well controlled) in both groups. No between group difference was found between CBT and MRT on panic or asthma control. The attrition rate was high in both groups (CBT = 41%, MRT = 38%). Conclusions: Both CBT and MRT may be efficacious treatments for comorbid asthma-PD, although additional research is needed due to the small sample size, high attrition rate, and lack of between-group differences on preliminary analyses. 28 Psychological and physiological effects of exposure to inhaled environmental toxins and irritants Nancy Fiedler, PhD nfiedler@eohsi.rutgers.edu Environmental and Health Sciences Institute, Rutgers – The State University of New Jersey, Piscataway, NJ, USA Background: Respiratory symptoms such as shortness of breath and chest tightness are common symptoms among community-dwelling individuals exposed to inhaled environmental toxins even at concentrations not expected to produce respiratory distress. Discerning a dose response relationship among chemical exposures, respiratory symptoms, and objective measures of respiratory function requires precise measurement of chemical exposure conditions in conjunction with assessment of respiratory function which can most effectively be accomplished with controlled exposures. Methods: Our controlled exposure laboratory at the Rutgers Environmental and Occupational Health Sciences Institute has conducted controlled exposures to methyl tertiary butyl ether (MTBE) (N= 12 MTBE sensitives; 19 healthy controls), hydrogen sulfide (N= 74 healthy subjects), diesel vapors (N= 12 ill, 19 healthy Gulf war veterans), and mixtures of volatile organic compounds (N= 130 healthy female subjects) at environmentally relevant concentrations. In repeated measures designs, symptom questionnaires, psychophysiologic responses relevant to the exposures, and computerized tests of cognitive function are administered at baseline prior to exposure onset, at several points during exposure, and immediately following exposure. After controlling for baseline responses at each exposure session, subject responses during filtered air or low exposure conditions are compared to health effects assessed during and after exposure to increasing concentrations of the toxicant. Results: Odor unpleasantness, anxiety, cognitive and respiratory symptoms were significantly increased immediately following the onset of exposure to hydrogen sulfide and diesel vapors. Immediately following exposure to diesel vapors, veterans diagnosed with Gulf war illness exhibited greater respiratory variability, systolic blood pressure, and a significant decline in end-tidal CO2 relative to healthy Gulf war controls, indicating a hyperventilation response to exposure. Relative to controls, ill Gulf War veterans also exhibited hyporeactivity in response to a computerized task of vigilance. Relative to filtered air, exposure to VOC mixtures with or without ozone among healthy female subjects did not result in significantly different symptoms, reduced cognitive performance or changes in lung function. Although individuals reporting sensitivity to MTBE reported significantly greater total symptoms than healthy controls during the highest exposure condition (15% MTBE), no differences in respiration rate or other psychophysiologic responses were observed. Conclusion: Although respiratory symptoms are frequently reported in response to chemical exposures, changes in respiratory function are not demonstrated among otherwise healthy individuals. In our laboratory, the most compelling respiratory effect was observed among subjects who were chronically ill and this effect was associated with hyperventilation and anxiety. Future studies of responses among individuals at risk for respiratory symptoms such as asthmatics may be more fruitful in understanding community responses to chemical exposures. 29 A pilot study of brief heart rate variability biofeedback to reduce craving in young adult men receiving inpatient treatment for substance use disorders David Eddie, M.S. Chrys Kim, PsyD,1 Paul Lehrer, PhD, 1 Erin Deneke, PhD, 2 Marsha E. Bates, PhD1 1Rutgers 2 – The State University of New Jersey, Piscataway, NJ, USA Caron Treatment Centers, Wernersville PA, USA Objectives: The present pilot study investigated the implementation feasibility, and efficacy for reducing alcohol and drug craving, of a brief, 3-session heart rate variability biofeedback (HRV BFB) intervention added to a traditional 28-day alcohol and drug use disorder inpatient treatment program. Methods: Forty-eight young adult men received either treatment as usual (TAU) plus three sessions of HRV BFB training over three weeks, or TAU only. Participants receiving HRV BFB training were instructed to practice daily using a hand-held HRV BFB device. Results: HRV BFB training was well tolerated by participants and supported by treatment staff. Participants receiving TAU + HRV BFB demonstrated a greater, medium effect size reduction in alcohol and drug craving compared to those receiving TAU only, although this difference did not reach statistical significance. Hierarchical regression analyses of residual craving change scores yielded significant group by HRV interaction effects wherein baseline levels of HRV were predictive of changes in craving only in the TAU group: Lower baseline levels of HRV were associated with increases in craving from start to end of treatment, whereas higher baseline HRV levels were associated with greater decreases in craving by the end of treatment. In the TAU + HRV BFB group, however, there was no such association. That is, HRV BFB appeared to dissociate individual differences in baseline HRV levels from changes in craving. Conclusions and Implications: Given that alcohol and drug craving often precipitate relapse, HRV BFB merits further study as an adjunct treatment to ameliorate craving experienced by persons with alcohol and drug use disorders. 30 The effect of slow diaphragmatic breathing on heart beat event related potentials (HEPs) Richard Gevirtz, PhD rgevirtz@alliant.edu California School for Professional Psychology,San Diego, CA, USA Background. Recent reviews have shown that biofeeedback techniques that use slow abdominal breathing can reduce anxiety and depression to a greater extent than relaxation interventions. Although a number of mechanisms may mediate this effect, based on recent findings using an implanted vagal nerve stimulator, a likely candidate is vagal afferent activity into the NTS and projected to Broadman area 25. Methods. To test this hypothesis, we have conducted studies that look at the effect of various maneuvers on the heartbeat evoked potential (HEP). The HEP is an event-related EEG response that is triggered by the R-wave of the ECG. The results of two studies are presented that demonstrate that the HEP is affected by both short term and long term slow breathing interventions. Discussion. We speculate that this effect is mediated by the vagal afferent pathway. 31 Activation of chemosensors in the lung stimulates breathing Juan Guardiola, MD, Jerry Yu, BM, PhD jerry.yu@louisville.edu Robely Rex VA Medical Center and Pulmonary Medicine, University of Louisville, Louisville, KY, USA Background: Breathing pattern is under the control of the central nervous system (CNS), which is regulated by feedback information in the lung via the vagus nerve (Lee and Yu, 2014; Comprehensive Physiol 4:287-324). Hyperpnea and tachypnea are common respiratory pattern in a variety of pulmonary diseases such as asthma, pneumonia, chronic obstructive pulmonary disease, pulmonary embolism, adult respiratory distress syndrome, and left heart failure. Therefore, we hypothesize that chemical mediators released into the lung during pulmonary diseases stimulate chemosensitive afferents (chemosensors) in the vagus nerve, which in turn alters the CNS activity and then breathing pattern. Methods: To test this hypothesis, we examined neural activities of vagal chemosensors (unmyelinated (histamine, bradykinin, and 5-HT), cytokines (TNF-α and IL-1β), and chemosensor activators (H2O2, hypertonic saline and oleic acid) in open-chest and mechanically-ventilated rabbits. In a separate group of rabbits, we examined respiratory pattern (assessed from the integrated phrenic efferent neurogram) in response to the stimulating agents. Results: We found that these testing agents stimulated chemosensitive afferents vigorously. Furthermore, these agents stimulated breathing. For example, injection of hypertonic saline (0.1 ml 8.1% NaCl) or H2O2 rate (61±10% and 43±8%, respectively, n=30) of phrenic neuroengram, indicating hyperpnea and tachypnea. This chemically mediated hyperpnea and tachypnea disappeared after bilateral vagotomy. Discussion: Our results support that chemosensors in the vagus nerve is a common pathway for lung-brain communication during pulmonary diseases. Since hyperpnea and tachypnea cause hyperventilation, which increases work of breathing therefore promotes ventilatory failure during pulmonary diaseases, activation of chemosensors could be detrimental. 32 Respiratory disease and executive functioning among adults in the United States Alice Grinberg, MA, EdM 1 alice.grinberg@gmail.com Renee Goodwin, PhD, MPH 1, 2 1 Department of Psychology, City University of New York (CUNY), Flushing, New York, 11367, USA 2 Department of Epidemiology, Mailman School of Public Health, New York, New York, USA Background: The goal of the current study was to investigate the relationship between respiratory disease and impairments in neuropsychological functioning among adults in the United States. Method: Data were drawn from the Midlife Development of the United States (MIDUS), a nationally-representative survey of adults in the United States (N=3259). Ordinary least squares were used to estimate the relationship between respiratory disease and various neuropsychological measures. Analyses were run separately for adults below and at/above the age of 50, adjusting for demographic characteristics and various measures of physical and mental health, including body mass index (BMI), history of a heart attack, stroke, or diabetes, history of smoking cigarettes, a current diagnosis of Major Depressive Disorder (MDD), and ratings on a self-reported measure of quality of life (i.e., Activities of Daily Living). Results: After controlling for demographic characteristics and health status, respiratory disease was associated with significant declines in executive functioning compared to those without respiratory disease. Adults with respiratory disease 50 years and older were at significantly greater risk for executive decline than those 50 years and older without respiratory disease. There was no association among adults younger than 50 years old. Discussion: Adults with respiratory disease may be at increased risk for declines in executive functioning later in life. If these findings are replicated, screening and preventive interventions aimed at preventing cognitive decline in people with respiratory disease may be advantageous 33 The effect of expiratory muscle strength training (EMST) on urge-to-cough in stroke patients Karen W. Hegland, PhD/CCC-SLP 1 kwheeler@ufl.edu Michelle S. Troche, PhD/CCC-SLP,1 Floris Singletary, MS/CCC-SLP,2 Paul W. Davenport, PhD3 1Department of Speech, Language, and Hearing Sciences University of Florida 2Brooks Rehabilitation Clinical Research Center Jacksonville, FL, USA 3Department of Physiological Sciences University of Florida Background: Disordered swallowing following stroke is common, but typically resolves within the first month post-stroke. However, aspiration pneumonia continues to be a leading cause of death in the 5 years post-stroke. The urge-to-cough (UtC) provides a measure of respiratory sensation related to an irritating airway stimulus. Evidence suggests that blunted UtC ratings relate to airway protection deficits in patients with neurologic disease. The goal of this study was to determine the effect of a respiratorybased rehabilitation paradigm on the UtC of participants post stroke. Method Twelve participants with a history of ischemic stroke within the previous 12 months were recruited for this study. Baseline tasks included maximum expiratory pressure (MEP) measurement and a cough challenge to three trials of 200 μM capsaicin. Following each capsaicin presentation participants rated the UtC on a modified Borg scale. The same measures were repeated following 5 weeks of EMST. A repeated measures analysis of variance was used to determine whether there were significant differences for UtC and MEP pre and post EMST. Results: At baseline, all participants demonstrated a blunted UtC to 200 μM capsaicin when compared to previously published data on healthy adults. Following 5 weeks of EMST, UtC increased from an average of 2.67 to 3.95. MEP also increased by an average of 30cmH2O post training. Discussion: The results of our study show that UtC is blunted in post-stroke patients, and that a respiratory strength training paradigm improves both expiratory muscle strength and the UtC sensation in response to cough inducing stimuli. This may relate to positive pressure in the upper airway and subsequent sensory stimulation that occurs during the EMST task. This is an important finding given that the perception of UtC is a critical component in the generation of an effective cough response to aspirate material. 34 Let’s talk about asthma and vocal cord dysfunction Charles Irvin, PhD Charles.irvin@uvm.edu University of Vermont, Burlington, VT, USA Asthma is a common chronic lung disorder for which there are well-codified diagnostic criteria and treatment schemes. On the other hand vocal cord dysfunction (VCD) is a frequent syndrome that can be mistaken for asthma but where the diagnostic criteria are ill defined and treatment is largely based on expert opinion. Vocal cord dysfunction (VCD) can occur with or without asthma but in either case these patients present a difficult diagnostic challenge. Failure to recognize VCD is important as it leads to unnecessary treatment and contributes to patient morbidity. The neural control and innervation of the larynx is complex and multiple factors have been identified that lead to abnormal adduction and airflow limitation. Unfortunately, the literature on this disorder is largely made up of small studies and anecdotal communications. Diagnosis is difficult and little agreement exists as to the best approach. Laryngoscopy is held to be the gold standard but inspiratory flow volume loops can be helpful and are not invasive. A myriad of treatments have been proposed for VCD including drugs (e.g. racemic epipherine), treatment of post nasal drip, GERD, botox, hypnotherapy, biofeedback but the most commonly used treatment is speech pathology therapy. Further investigations into the causes, natural history and in particular better, validated diagnostic approaches are needed. Assessment of treatment effectiveness is clearly necessary. Accordingly, the causes and cures for VDC provide a rich opportunity for research. 35 The impact of harmfulness information on urge-to-cough during citric-acid inhalation. Thomas Janssens, PhD, Thomas.Janssens@ppw.kuleuven.be Sarah Brepoels, MA, Lieven Dupont, MD, PhD & Omer Van den Bergh, PhD KU Leuven (University of Leuven), Belgium Background: The cough reflex is an automatic reflex, but it can be modulated by a conscious effort to augment or suppress cough. Furthermore, evidence is emerging that cough reflexes are modulated by other forms of top-down cortical control. In this experiment, we investigated the role of perceived harmfulness on cough reflex sensitivity. Due to the defensive nature of the cough reflex, we hypothesized that an increase in perceived harmfulness would increase cough reflex sensitivity and associated urge-tocough. Methods: Healthy participants (n=39) Received information that the substance they were to inhale was harmless (natural citric acid), or potentially harmful (a potent agrochemical). Subsequently, they participated in a two-step cough challenge test, using dosimeter controlled citric acid inhalations. First, the dose eliciting at least three coughs (C3) was determined. Subsequently, participants received repeated presentations of the C3 dose, a subthreshold dose of citric acid and placebo. Results: C3 thresholds were not influenced by harmfulness information, but only 27/39 participants reached C3. During repeated citric acid presentations, the group that received information that the cough inducing substance was a potentially harmful chemical showed a greater urge-to-cough compared to the group that was told that the cough-inducing substance was natural citric acid (F(1,24) = 10.15, p < .01). Cough frequency was not influenced by the harmfulness information. Conclusion: Our findings show that harmfulness information is an important factor in the perception of urge-to-cough and suggests that a reduction of perceived harmfulness may be a beneficial symptom relief strategy in individuals that suffer from an increased urge-to-cough. 36 Prevalence of anti-inflammatory medication use in asthma patients Karenjot Kaur1 karenjot.kaur@rutgers.edu, Milisyaris Aviles, MS,2 Varsha Kurup,1 Frederick Wamboldt, MD,3 Shou-En Lu, PhD,4 Paul Lehrer, PhD5 1 Rutgers – The State University of New Jersey, New Brunswick, NJ, USA Department of Psychiatry, Rutgers -- Robert Wood Johnson Medical School, Piscataway, NJ, USA 3National Jewish Health, Denver, CO, USA 4 School of Public Health, Rutgers – The State University of New Jersey 2 Background. Asthma is an inflammatory disease which causes heightened airway irritability, and has intermittent symptoms precipitated by viral infections, cold air, exercise, pollutants, and psychological stress. The National Institute for Health recommends the use of Albuterol, inhaled steroids, and oral steroids for asthma control. Literature suggests that 50% of asthma patients do not use inhaled steroids as recommended. This study sought to recruit these patients in order to give them an alternative to the use of inhaled steroids despite having asthma exacerbations. Methods. The patients were recruited through posters, advertisements, and medical referrals which emphasized the need for non-smoking and non-steroid using patients. Information on patients’ asthma was collected through surveys, questionnaires, and physiological testing. Results. A large percentage of subjects was excluded from the study for not meeting criteria; exclusion rates were high. The excluded subjects’ responses in the collected data were analyzed to determine the major exclusion criteria. A sample of 530 self-proclaimed, non-smoking adult asthma patients, who were excluded from the study (50 were included), was used in this assessment. Through data observation, it was found that approximately 20% of these subjects, were either currently or previously heavy smokers. Other patients were excluded for having very mild asthma symptoms, or only seasonal symptoms. A majority of excluded subjects, approximately 30%, were using inhaled steroids, despite the study advertising the need for non-users. Discussion. We verified that smoking is a hindrance in asthma prevention and treatment and found that more individuals use inhaled steroids than suggested by the literature. This recommended use of inhaled steroids may have been due to geographic location, with several of the Central New Jersey subjects having easy access to medical care and drugs. These subjects may also have been less afraid of the side effects of inhaled steroids, suggesting their increased medical access and availability. 37 Breath, beats, and behavior: applied psychophysiology, stress management, and behavioral medicine Paul Lehrer, PhD Lehrer@rwjms.rutgers.edu Rutgers – Robert Wood Johnson Medical School, Piscataway, NJ, USA This talk reviews 45 years of psychophysiological research at Rutgers, and related research from around the world. Stress can produce dysregulation in various body systems. We review research on various forms of stress-related autonomic dysfunction, including parasympathetic as well as sympathetic overactivity and symptomatology. Changes in various parameters of respiration are important for normal regulation. They typically occur during exposure to stress. These include changes in bronchial tone, tidal volume, respiratory drive, and total ventilation. They often occur in the form of yawning and sighing. In normal function, respiratory changes aid in regulating acid base balance in the blood and adaption to exercise, altitude, air pollution, and changes in respiratory resistance. They also may affect autonomic regulation. Data on laboratory stressors are reviewed. Stress-related respiratory changes often produce a mismatch between physical demand for oxygen and respiration. Such effects can lead to respiratory dysregulation, and produce a host of physical and emotional symptoms, often mediated by hyperventilation. These may include headache, dyspnea, chest pain, muscle tension, performance decrements, confusion, and panic. Breathing slowly at about six breaths/min is a therapeutic intervention that may have powerful effects in combatting various sources of respiratory dysregulation. It protects against hyperventilation while maintaining oxygen saturation, prevents asthma exacerbations, and, through its effects on the baroreflex system, improves cardiovascular and emotional regulation. Yogis and Sherpas are often observed to breathe with this pattern, as do Zen monks. Data from a current trial suggest that it decreases airway reactivity to methacholine among asthma patients. It targets the parasympathetic system, and appears to stimulate parasympathetic regulatory components in cardiovascular regulation. These effects appear to be maximized when heart rate variability biofeedback is included as a way to teach optimal patterns of slow breathing, where resonance characteristics of the baroreflex system are stimulated, and gas exchange is maximized. Combinations of psychophysiological techniques may be particularly helpful for patients with multiple somatic symptoms and a pattern of somatization. 38 Heart rate variability biofeedback: its role in asthma therapeutics Paul Lehrer, PhD1 Lehrer@rwjms.rutgers.edu Frederick Wamboldt, MD,2 Evgeny Vaschillo, PhD,3 Charles Irvin, PhD,4 Milisyaris Aviles, MS,1 Jessica Graves, MA,2 Shou-En Lu, PhD5 1Department of Psychiatry, Rutgers – Robert Wood Johnson Medical School, Piscataway, NJ, USA Jewish Health, Denver, CO, USA 3Center for Alcohol Studies, Rutgers – The State University of New Jersey, Piscataway, NJ, USA 4University of Vermont, Burlington, VT, USA 5School of Public Health, Rutgers – The State University of New Jersey 2National Background. Previous research found the heart rate variability biofeedback (HRVB) allowed decreases in asthma medication, while producing improved pulmonary function, a reduction in asthma symptoms, and a complete elimination of asthma exacerbations. However, no mediators for this effect were found. Method. In the current study we tested the effects of biofeedback on airway reactivity to methacholine and exhaled nitric oxide, to determine whether the pathway may be autonomic or anti-inflammatory, and whether HRVB can be used as a substitute or complement to steroid medication. We also assessed effects of treatment on HF, LF, and VLF HRV, as well as these frequency ranges in pulse transit time and pulse amplitude, as indirect measures of vascular tone effects. Results. Here we present preliminary data on partial results from this two center trial. Fifty-five steroid-naïve adult patients with mild or moderate asthma were given either HRVB or a relaxation control, involving EEG alpha biofeedback, paced breathing at 15 breaths/min, and listening to relaxing music. Although we thus far have not found significant effects on resting levels of pulmonary function, we found a significant improvement on the methacholine challenge test only for the HRVB group. We also found a significant increase in LF and VLF pulse transit time variability, as well as a decrease in finger pulse amplitude, and increases in LF HRV. No effects were found for exhaled nitric oxide. Discussion. The results suggest that HRVB may be useful as a supplement to steroids, but not as a substitute. The decrease in reactivity to methacholine suggests modulation of reactivity of airway smooth muscles by increased baroreflex strength, a known effect of HRVB. The autonomic effects suggest increased baroreflex activity in both the heart rate and vascular tone closed loops of the baroreflex system. 39 Nicotine withdrawal severity moderates the relation between panic disorder status and physiological stress reactivity Teresa M. Leyro, Ph.D. 1 teresa.leyro@rutgers.edu Michael J. Zvolensky, Ph.D. 2 1 Rutgers – The State University of New Jersey, Piscataway, NJ, USA University of Houston, Houston, TX, USA 2 Background: Smoking onset is significantly and prospectively linked to the development of Panic Disorder (PD), placing these individuals at greater risk for more intense panic-relevant psychopathology and poorer smokingrelated outcomes. Nicotine withdrawal is one mechanism that may explain this relationship; for example, smokers with PD may over-attend to somatic sensations associated with nicotine withdrawal and may misinterpret them as threatening. We examined whether nicotine withdrawal moderates the relation between PD and panic reactivity via assessment of expired tidal levels of CO2 (ETCO2) to a laboratory challenge. Method: Using a between-subjects design, 58 nicotine-dependent smokers with and without PD were randomly assigned to refrain from smoking for at least 12 hours, or to smoke as usual, prior to participating in a 4-minute 10% carbon dioxide-enriched air (CO2) biological challenge, during which ETCO2 was continually indexed. Results: Participants were 58 adult smokers (M =19.7 cigarettes daily, SD = 8.0), and 36.2% met criteria for current PD. Self-reported nicotine withdrawal and PD status (via diagnostic interview) did not interact to predict pre- to post-challenge change in ETCO2. However, higher levels of nicotine withdrawal and positive PD status interacted to predict greater physiological reactivity to the challenge as indexed by ETCO2 levels measures in response to, and recovery from, the challenge over time (Time2 x PD status x nicotine withdrawal: t=-2.08, p<.05). Discussion: The current findings are the first to experimentally demonstrate that greater self-reported nicotine withdrawal interacts with PD status to predict greater physiological reactivity to, and slower recovery, from a CO2 laboratory stress provocation, as indexed via ETCO2. These findings suggest subjective nicotine withdrawal severity may exacerbate physiological panic reactivity in smokers with panic psychopathology. In addition, they suggest the need for further inquiry into physiologically relevant clinical intervention targets, such as ETCO2, for the treatment of smokers with co-occurring panic psychopathology. 40 Effects of heart rate variability biofeedback on airway inflammation Patrick Maulion1, pdm62@scarletmail.rutgers.edu Milisyaris Aviles, MS,1 Jessica Graves, MA,2 Frederick Wamboldt, MD,2 Shou-En Lu, PhD,1 Paul Lehrer, PhD1 1Rutgers – The State University of New Jersey, Piscataway, NJ, USA 2National Jewish Health, Denver, CO Background: An underlying process in asthma is considered to be airway inflammation that increases airway irritability. Most asthma patients are therefore treated with anti-inflammatory drugs, primarily inhaled steroids, which are taken as ‘controller’ medications, to prevent exacerbations, even when the patient is asymptomatic. However a large proportion of asthma patients are nonadherent to steroid treatment, primarily because of cost and fear of side effects. Heart Rate Variability Biofeedback (HRV-BF) is a non-pharmacological breathing therapy in which individuals are instructed to breathe at the rate determined by the resonance frequency of the baroreflex system, approximately 6 times a minute. Previous studies showed that HRV-BF improves airway function, decreases symptoms, allows less medication use, and prevents asthma exacerbations. The goal of this study was to see if HRV-BF decreases airway inflammation as measured by fractional exhaled nitric oxide (eNO). Methods: This is an interim analysis of a two-center clinical trial that is still ongoing. The study included 80 steroid naïve patients who were randomized into either HRV-BF (N = 36) or a combination of EEG biofeedback, paced breathing at a relaxed rate (~15 breaths/minute), and listening to relaxing musicrelaxation (N = 44). After a one-month run-in with asthma education, patients were given 6=10 sessions of training. Measures of eNO were taken at pre, mid and post treatment. The Aerocrine NIOX MINO System was used, following the manufacturer’s protocol. Data were analyzed using an ANOVA with a repeated measures design, through the SAS GLM program. The log transformation was used on parts per billion (ppb) eNO in order to normalize data. Results: Neither group showed a significant change in log eNO during the study, with no differences between groups. Means and s.d.’s of log eNO Group HRV-BF Music EEG Beginning of Tx 3.50 ± 0.76 3.80 ± 0.91 Mid Tx 3.52 ± 0.86 3.68 ± 0.91 End of Tx 3.60 ± 0.75 3.73 ± 0.93 Discussion: HRV-BF did not have a significant impact on eNO. Although other data show that HRV-BF has a potential for treating asthma, the path does not appear to be through decreasing airway inflammation. HRV-BF may thus function as a complement to treatment with inhaled steroids, not as an alternative. 41 Psychiatric symptoms, bronchodilator response, and symptom magnification in Latino children with asthma Elizabeth L. McQuaid, PhD1, elizabeth_mcquaid@brown.edu Nicole R. Nugent, PhD,1 Daphne Koinis-Mitchell, PhD,1 Ronald Seifer, PhD,1 Glorisa Canino, PhD,2 Gregory K. Fritz, MD1 1Bradley/Hasbro 2Behavioral Children’s Research Center, Alpert Medical School, Brown University, Providence, RI. Sciences Research Institute, University of Puerto Rico, Medical Sciences Campus, San Juan, PR Background: Stress and psychiatric symptoms may affect bronchodilator responsivity (BDR) in asthma, particularly among Latinos. Our prior data suggest that Latino children with asthma are more likely to overestimate lung function compromise (symptom magnification; SM). In this study, we investigate symptoms of anxiety and panic, and their relationship to BDR and SM among Latino children with asthma. Methods: 382 Latino children with asthma (ages 7-15) living in PR (n=242) and RI (n = 140; 59 PR and 81 DR) completed the BDR protocol involving pre-post bronchodilator reversibility. BDR was defined as: ([post-bronchodilator FEV1 – pre-bronchodilator FEV1]/pre-bronchodilator FEV1) x 100. A subset of 246 children also completed five weeks of our standard symptom perception protocol involving serial subjective and objective lung function assessments. The degree of SM for each child was quantified using our Asthma Risk Grid. The DISC Predictive Scales, Youth Report (Y-DPS) were used to assess symptoms of anxiety and panic. Multivariate modeling was used to examine anxiety and panic symptoms in relation to BDR and SM, controlling for age, gender, smoke exposure, income, and site. Results: Controlling for relevant covariates, children with significant symptoms of panic and anxiety had a reduction in BDR of 2.0% (p < .05) compared to those without symptoms. Multivariate analyses did not reveal associations between anxiety or panic and SM; however, covariates of child sex, site, and income remained predictors of SM. Discussion: In our sample of Latino children, psychological symptoms had modest associations with impaired BDR, but not with SM. Factors associated with chronic disadvantage, many of which occur in combination, likely contribute to symptom perception in this group. 42 Pilot study of hypoventilation treatment on anxiety in patients with asthma Alicia E. Meuret, PhD1, ameuret@mail.smu.edu David Rosenfield, PhD,1 Ashton M. Steele, MA,1 Mark. M. Millard, MD,2 Thomas Ritz, PhD1 1Southern 2Baylor Methodist University, Dallas, Texas, USA University Medical Center, Dallas, Texas, USA Background: There is a high prevalence of anxiety in patients with asthma. Research suggests that anxiety exacerbate asthma symptoms and health care utilization and, conversely, asthma symptoms and medication may complicate anxiety treatment. Effective, non-pharmacological interventions to improve anxiety in asthma are needed. A marker common to both is hyperventilation which has been linked to adverse effects on lung function, symptoms, and well-being in asthma and fear in anxiety sufferers. We determined whether reducing hyperventilation improves anxiety in patients with comorbid anxiety and asthma. Methods: 120 adult patients with asthma, aged 20-65, English- or Spanish-speaking, were enrolled in an NIH-funded 4-week, 5 session training. Patients were randomly-assigned to receive capnometry-assisted respiratory training (CART) for raising PCO2 or feedback in slowing of respiratory rate (SLOW) to improve asthma symptoms and lung function. Anxiety was not directly targeted. Results: Twenty-six patients met criteria for clinically relevant anxiety levels (HADS, anxious mood ≥8). Anxiety symptoms (measured by ASI, PANAS negative items, and HADS-A) were substantially reduced in the high anxiety patients receiving CART (effect size d=1.30 for ASI, d=.52 for PANAS, and d=.62 for HADSA), while they remained stable in the SLOW condition. Further, the Anxiety by Treatment by Time interactions were significant for all three anxiety outcomes (ps<.05), with the advantage of CART over SLOW on improvement in anxiety being greater for high than for low anxiety patients. In addition, while high anxiety participants in the SLOW condition had decreasing quality of life over the course of the study, high anxiety participants in CART maintained their quality of life over time, and were equivalent to the low anxiety patients. Conclusions: Brief training in reducing overbreathing by means of raising PCO2 led to significant and sustained reductions in both asthma and anxiety symptoms. The findings lend support for PCO 2 as a critical factor for anxiety reduction in asthma. 43 Management of psychological comorbidities in females with copd in a rural healthcare setting Sarah Miller, PhD, RN1 sarahmilleruf@gmail.com Erin Silverman, PhD2, 3, 4, Belinda Fleming, PhD, ARNP1 1 University of Memphis, Memphis, TN; of Physiological Sciences, University of Florida, Gainesville, FL 3North Florida South Georgia Veteran’s Health System, Malcom Randall VAMC 4Rehabilitation Outcomes Research Center – Malcom Randall VAMC, Gainesville, FL 2Department Background & Purpose. The purpose of this study was to investigate the management of, factors related to, and prevalence of psychological comorbidities in adults with chronic obstructive pulmonary disease (COPD) in a rural healthcare setting. Methods. A retrospective chart analysis of all adults with a COPD diagnosis (ICD 496.0) seen within a rural setting from December 1, 2010 to May 31, 2010 was utilized. A total of 232 charts were randomly selected for complete analysis. The following variables were examined: gender; presence of psychological comorbidity diagnoses (anxiety, depression); physiological comorbidities; the number of controller breathing medications, anxiolytics, and antidepressants prescribed; access to healthcare and insurance; smoking history; BMI; age; FEV1% of predicted; and FEV1/FVC% of predicted. Results Females were more likely (p=<.001) to have a current psychological comorbidity and related prescription. However, there was no screening process, and medical management was responsive rather than preventative or supportive. Females reported psychological manifestations while reporting their chief complaint, but males did not. FEV1% and FEV1/FVC% of predicted scores were associated with the presence of anxiety & depression. The majority of patients (92%) had a physiological comorbidity, of which hypertension (81.8%), diabetes mellitus (43%) and congestive heart failure (32%) were most prevalent. The presence of a physiological comorbidity was related to the presence of a psychological comorbidity. There were no significant relationships in healthcare access and psychological comorbidity diagnosis, but patients with self-pay (no insurance) were less likely to comply with spirometry orders. Discussion & Clinical Implications In clinical practice, early screening and psychological evaluation will identify women with COPD who are at higher risk for anxiety and depression. Females with COPD demonstrate increased physical and psychological burden from their disease, yet there is no specialized treatment plan to screen and address this population. NICE guideline 91 highlights the importance of early identification of patients with a chronic health condition, such as COPD, who are at increased risk for depression and functional impairment (NICE, 2014). The guidelines address disease-associated mood fluctuations, loss of pleasure in activities, pain, functional impairment and disability that can increase the risk of depression and anxiety. Early recognition, supportive care and treatment can ease the burden of psychological comorbidities in patients with COPD. This presentation will compare and contrast existing recommendations for patient management with new recommendations based upon this current data. 44 The relationship between heart rate variability, depression, and anxiety: baseline findings from a randomized controlled trial of a panic disorder intervention for latino adults with asthma Tanya Oken, BA.1 okentt@gmail.com Jonathan M. Feldman, PhD,1 Paul Lehrer, PhD2 1Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA 2Rutgers – The State University of New Jersey, Piscataway, NJ, USA Background: Reduced HRV is implicated in mood and anxiety disorders. The aim of this study is to explore the relationship between depression and panic disorder (PD) on HRV in asthmatics. Methods: Psychiatric diagnoses were determined by structured clinical interview (SCID). Baseline psychophysiological recordings for 46 female participants with PD and asthma were analyzed in 5-min epochs of time. Time and Frequency bands were set according to established standards. Natural log transformations of the LF, HF, and RMSDD index, were included as HRV outcome measures. Respiration and participant age were included as covariates. The Beck Depression Inventory (BDI) and Panic Disorder Severity Scale (PDSS) were used as measures of depression and PD. Results: 47.9% (N=22) of participants met SCID criteria for a current depressive disorder. Hierarchical regressions revealed that the BDI (M=23.48, SD=12.12) and PDSS (M=16.52, SD=4.13) were not significant predictors of HRV as measured by log transformed LF (M=2.26, SD= .76), HF (M=2.21, SD= .88), and RSMDD (M=1.36, SD= .40), and were excluded from analyses. Age (M=43.61, SD=12.05) and respiration (M=16.08, SD=4.09) explained 31.1% of the variance in LF (R2 = .311, F (2, 38)=8.59, p < .01), 28.9% of the variance in HF (R2 = .289, F (2, 38)=7.92, p < .01), and 19% of the variance in RSMDD (R2 = .19, F (2, 38)=4.47, p < .05). Age was a significant predictor of HF (β = -.45, p < .01), LF (β = -.43, p < .01), and RSMDD (β = -.44, p < .01). Respiration significantly predicted HF (β = -.30, p < .05) and LF (β = -.53, p= .01), but not RSMDD (β = -.03, p > .05). Discussion: When controlling for age and respiration, the PDSS and BDI did not explain the variance in baseline HRV for participants with PD and asthma. 45 The relationship between acculturation, asthma psychological triggers, and utilization of quick relief medication in Mexican and Puerto Rican families Esperanza Morales Raveendran, PhD1 esperanza.morales@nyu.edu Kimberly Arcoleo, PhD, MPH, 2 Jonathan Feldman, PhD1 1Ferkauf 2Ohio Graduate School of Psychology Yeshiva University; New York, USA State University College of Nursing, Columbus, OH, USA Objective: The present study examined the association between caregivers’ level of acculturation, psychological triggers of asthma, and use of children’s quick relief asthma medication. Method: 263 Mexican and Puerto Rican children between ages 5 and 12 with physician-diagnosed asthma and their caregivers were recruited from two distinct locations: Phoenix, Arizona and the Bronx, New York. The dyads completed structured interviews using the Stephenson Multigroup Acculturation Scale (SMAS) and Asthma Trigger Inventory (ATI). Use of quick relief medication data were gathered by attaching counting devices called Dosers to the child’s quick-relief metered dose inhalers. Results: Pearson’s correlations found no significant relationships between psychological triggers of asthma, ethnic society immersion level of acculturation, r (263)= -.06, p=.34 nor dominant society immersion level of acculturation r (263)= -.08, p=.20. Additional Pearson’s correlation between reported psychological triggers and use of quick relief asthma medication r (235)= .08, p=.21 revealed no significant relationship. An independent t-test revealed no between group differences between Puerto Ricans (M=.40, SD= .57) and Mexicans on reported psychological triggers of asthma (M= .49, SD=.63, p=.26) t( 261) =1.07. Puerto Rican caregivers scored higher on the dominant society immersion subscale (M=3.40, SD=.44, p<.001) than Mexican caregivers (M=2.98, SD=.40, p=.90). Lastly, a hierarchical linear regression was used to examine the proportion of variance of quick relief medication use explained by reported psychological triggers after controlling for acculturation level. Psychological asthma triggers were not a predictor of quick relief medication use ( =-.061, p=.36). Discussion: Puerto Ricans caregivers have a higher level of acculturation than Mexican caregivers. There was no relationship between reported psychological triggers, ethnicity and use of quick relief medication. These findings are not consistent with previous research showing that acculturation may play a role in asthma health outcomes. 46 Correcting respiratory sinus arrhythmia for respiratory influences: Findings with an infant stress paradigm Thomas Ritz, PhD1 tritz@mail.smu.edu Michelle Bosquet Enlow, PhD,2 Lucy King BA,2 Stefan M. Schulz PhD3, and Rosalind J. Wright, MD, MPH4 1 Southern Methodist University, Dallas, TX, USA Boston Children's Hospital and Harvard Medical School, Boston, MA, USA 3. University of Wuerzburg, Wuerzburg, Germany 4 Icahn School of Medicine at Mount Sinai, New York, NY, USA 2 Background. The amplitude of respiratory sinus arrhythmia (RSA) can be increased by slower and deeper breathing independent of vagal activity. This effect is well-documented in adults and correction procedures have been devised to control for this confound. However, less is known about the role of respiratory pattern influences in infant RSA. We recently found evidence for the usefulness of respiratory corrections in a smaller study using an infant stress paradigm. Method. The present study sought to replicate these findings in a larger sample (N=181). Infants were administered the Still Face Test, in which they are confronted with their mother terminating interaction and maintaining a neutral face for 2 min, followed by a 2-min reunion phase with re-established interaction. Two sequences of this test were administered unless infants became too distressed by the first sequence. Typically, decreases in RSA would be expected during the challenge phase of the test. However, results showed that infants’ respiration rate decreased and tidal volume increased at the same time, which can mask the expected effects in RSA. Results. Normalization of RSA by tidal volume and within-individual correction for respiration rate substantially improved the demonstration of RSA attenuation during stress, for both infants completing one and infants completing two sequences of the test. Discussion. In conclusion, studies of infant RSA can substantially benefit from respiratory correction procedures that control for respiration rate and tidal volume. 47 Hypoventilation training in asthma: Results from a capnometry-assisted breathing training trial Thomas Ritz, PhD1 tritz@mail.smu.edu David Rosenfield, PhD,1 Ashton M. Steele, MA,1 Mark. M. Millard, MD,2 Alicia E. Meuret, PhD1* 1Southern 2Baylor Methodist University, Dallas, Texas, USA University Medical Center, Dallas, Texas, USA Background. Hyperventilation has been associated with adverse effects on lung function, symptoms, and well-being in asthma. We examined the effects of adjunctive breathing training aimed at raising end-tidal carbon-dioxide levels (PCO2) on asthma symptoms and pathophysiology. Method. 120 adult asthma patients were enrolled in a randomized-controlled trial to receive biofeedback training for either raising PCO2 (capnometry-assisted respiratory training, CART) or slowing respiratory rate (SLOW). Interventions consisted 5 sessions over 4-weeks with twice daily home training assignments. The primary outcomes were asthma control, PCO2, and diurnal PEF variability. Secondary outcomes included asthma symptoms, medication use, spirometric lung function, respiratory resistance, airway inflammation, airway hyperreactivity, and quality of life. Results. CART, but not SLOW patients achieved sustained increases in PCO2 throughout treatment and follow-up. Significant improvements were found across most outcome measures in both groups, including aspects of lung function and airway hyperreactivity tested by methacholine challenge. CART patients showed lower respiratory resistance during therapy and superiority in long-term symptom reduction at 6month follow-up. Discussion. Thus, breathing training aimed at raising PCO2 or slowing respiration rate leads to sustained improvements in asthma symptoms and lung function. Raising PCO2 resulted in greater benefits in aspects of lung function and long-term symptoms. 48 Asthma-Related Death of a Loved One, Panic Disorder, and Ataque de Nervios in Latino Adults with Asthma Jonathan M. Sandler, MA jonmsandler@gmail.com Jonathan M. Feldman, PhD Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA Background: Research has demonstrated high co-occurrence of asthma and panic disorder (PD) in the general population, as well as the role that psychosocial stressors play in such comorbidity. Yet less is known about the relationship between asthma and the Latino culture-bound syndrome of ataque de nervios. This study therefore investigated correlations between the self-reported death of a loved one due to asthma and the prevalence of PD and ataque de nervios in a Latino sample of adults with asthma. Methods: Data originated from a randomized controlled trial in which Latino adults (N = 490) were recruited from outpatient hospital clinics in the Bronx, New York. Diagnosis of PD was determined by the Patient Health Questionnaire (PHQ), while lifetime history of ataque de nervios was based upon selfreport. Participants were also administered the Asthma Trigger Inventory (ATI). Results: Chi-square analysis revealed a significant association between self-reported asthma-related death of a loved one and ataque de nervios [X2(1) = 10.6, p = .001]. Participants reporting asthma-related deaths also scored significantly higher on the psychological trigger subscale of the ATI (M = 1.66, SD = 1.00) than did those not reporting such deaths (M = 1.40, SD = 0.98), t(428) = -2.51, p = .012, and significantly lower on perceived ability to control ATI triggers (M = 1.45, SD = 0.91) than did those not reporting such deaths (M = 1.64, SD = 0.91), t(413) = 2.03, p = .043. Self-reported asthma-related death of a loved one was not associated with PD [X2(1) = 0.94, p = .33]. Discussion: These findings suggest the clinical importance of assessing for family history of asthma-related deaths in Latino patients with asthma and ataque de nervios, as such history may negatively impact perceived vulnerability to psychological triggers of asthma and perceived control of asthma triggers in general. 49 Assessing differential effects of fear and anxiety to respiratory threat. Mathias Schroijen1 Mathias.Schroijen@ppw.kuleuven.be Simona Fantoni,1 Carmen Rivera,1 Bram Vervliet,1 Koen Schruers,1,2 Omer Van den Bergh, PhD,1 Ilse Van Diest, PhD1 1KU Leuven - University of Leuven, Belgium. University, the Netherlands. 2Maastricht Background: When respiratory sensations engage the behavioral defensive system (interoceptive threat), it is hypothesized that two functionally distinct states, namely fear and anxiety may ensue. Each of which are thought to play a prominent role in the etiology of panic disorder (Bouton et al., 2001). A first study (N= 48) aimed to validate the difference between anxiety and fear towards a respiratory threat. A second study (N= 17) aimed to explore whether fear and anxiety may differentially influence perceptual sensitivity and response bias towards respiratory sensations. Method: In both studies, a modified version of the NPU-threat test (Schmitz & Grillon, 2012) was used with a respiratory aversive stimulus. Participants breathed through a tube during three experimental conditions: a neutral condition without respiratory threat (N), a predictable (P) and an unpredictable (U) respiratory threat condition. A breathing occlusion, making it briefly impossible to breathe, served as the respiratory threat stimulus and was signaled by a visual signal cue in the P or unrelated to the cue in the U condition. Startle blink responses, electrodermal activity, respiration and heart rate were measured. In the second study, a Signal Detection Task (SDT-task) was added to this modified NPU-test. Participants had to categorize one out of two inspiratory resistive loads as the lighter or the stronger one during each of the three conditions (N, P, U). Results and Discussion: The first study showed that both fear and anxiety-potentiated startle responses were successfully elicited by predictable and unpredictable respiratory threat, respectively. Furthermore, inter-individual differences in fear of suffocation importantly moderated the fear-potentiated, but not the anxiety-potentiated startle. Perceptual outcomes of the SDT-task in the second study will also be discussed 50 The effect of parental social support and acculturation on childhood asthma control Bari Scheckner, MA1 Bari.Scheckner@psych.ferkauf.yu.edu Kimberly Arcoleo, PhD, MPH,3 Jonathan M. Feldman, PhD1,2 1Ferkauf Graduate School of Psychology, Yeshiva University, NY of Epidemiology and Population Health, Albert Einstein College of Medicine, NY 3Ohio State University College of Nursing, OH 2Department Background: There exists large ethnic disparities in asthma among Latino children; Puerto Ricans (PR) are disproportionately affected, while Mexicans have the lowest prevalence and morbidity. Disparities are poorly understood, however, acculturation and social support are suggested to influence asthma control among children. This study investigated the relationship between acculturation, social support, and asthma control among PR and Mexican children and their caregivers. Methods: Primary caregiver-child dyads (N=267) of PR (n=79) and Mexican (n=188) descent were recruited from clinics at two inner-city hospitals in Bronx, NY and three clinics in Phoenix, AZ. Children were 5-12 years of age and had a confirmed asthma diagnosis. Dyads completed measures of social support, acculturation and asthma control. Logistic regression was used for analysis. Results: Mexican children had better asthma control than PR children (p<.001). PR caregivers were more acculturated than Mexican caregivers (p<.05); however, acculturation did not predict control. Across Latino subgroups caregivers’ total level of social support predicted better asthma control among children (p<.05), and support received from family and friends each independently predicted better control (p<.05). Discussion: Results suggest that social support reduces some of the burden associated with asthma management enabling caretakers to better control their children’s asthma. For example, caregivers who perceive greater support may have greater self-efficacy regarding their ability to manage these difficulties, and they may practically have more assistance in doing so (e.g., family/friends to babysit, multiple sources of financial assistance). The lack of an association between acculturation and control may be an artifact of the ethnic communities in which this study was conducted, which may limit pressures for acculturation. Alternatively, however, research in this area is limited and existing studies widely vary in their measurement of acculturation, making it difficult to generalize across studies. 51 Assessment of dystussia in TBI Erin Silverman, PhD1,2,3 epearson@ufl.edu Sarah Miller, PhD, RN,4 Christine Sapienza, PhD,5 Paul W. Davenport, PhD1 1Department of Physiological Sciences, University of Florida, Gainesville, FL Florida South Georgia Veteran’s Health System, Malcom Randall VAMC); 3(Rehabilitation Outcomes Research Center – RORC, Malcom Randall VAMC, Gainesville, FL); 4(University of Memphis, Memphis, TN); 5 (Jacksonville University, Jacksonville, FL) 2(North Background: Symptoms associated with traumatic brain injury (TBI) may include airway compromise in the form of impaired cough or dystussia. The presence of impaired cough places an individual at increased risk for uncompensated aspiration. Aspiration is very common in individuals with TBI and typically takes the form of silent (aspiration followed by no cough response) in almost half of all individuals with TBI (Terre & Meari, 2007). Cough function and urge to cough have .D. been studied in a number of cohorts including healthy controls, Parkinson’s Disease, stroke, and Amyotrophic Lateral Sclerosis, however there has been no systematic investigation of these functions in those with TBI. Personal communication with physicians and rehabilitation staff at Walter Reed Army Medical Center has revealed that issues relating to airway compromise in many individuals with TBI and that these issues persist even following discharge from medical facilities. Therefore the central aim of this project was to quantify and describe various physiological aspects of airway compromise, including cough impairment, in those with TBI. Methods: A capsaicin cough challenge was administered to three individuals who had sustained a TBI within the preceding 5 years. Global severity ratings were obtained in the form of Montreal Cognitive Assessment (MOCA) and Rancho Los Amigos (RLAS) scores. Participants were administered a randomized block series of capsaicin and saline solution at the following concentrations (µM): 0, 50, 100, 200, and 500. Each concentration was administered 3 times for a total of 15 administrations via a standard respiratory facemask connected to a nebulizer. Cough responses were recorded by pneumotachograph and the cough airflow signal was digitized and recorded onto a desktop computer (Chart, ADInstruments). Cough counts were obtained following each capsaicin solution administration. Participants were also instructed to rate their urge to cough using a modified Borg scale where 1 equals no urge and 10 equals maximum urge. Cough counts and urge to cough ratings were compared to data previously obtained from healthy normal control subjects. Results: Significant differences were observed relative to number of coughs and urge to cough. TBI patients coughed less and had a lower urge to caugh. Discussion: These results show apparent differences in cough response including urge to cough in participants with TBI compared with existing data obtained from healthy controls. Clinical and rehabilitation considerations are discussed within the context of these findings. 52 Effects of heart rate variability biofeedback on peak expiratory flow rates in steroid-naïve patients with mild or moderate asthma Michael Singer1 spaceman792@live.com Gabriel Pontipiedra,1 Kevin Ma,1 Nimesh Patel,1 Patrick Maulion,1 Milisyaris Aviles, MS,1 Jessica Graves, MA,2 Shou-En Lu, PhD,1 Frederick Wamboldt, MD,2 Paul M. Lehrer, PhD 1 1Rutgers—The State University of New Jersey, New Brunswick and Piscataway, NJ, USA2National Jewish Health, Denver, CO, USA Background. Asthma is a chronic disease of the airways, it has varying severity and symptoms but typically presents with increased airway reactivity to irritants. As of now, there is no cure for asthma, although medications can alleviate exacerbations and symptoms. Inhaled corticosteroids are usually prescribed as controller medication, but studies have shown low rates of adherence, primarily because of cost or fear of adverse side effects. The goal of this study is to evaluate the effectiveness of heart rate variability biofeedback (HRV-BF) as a supplement or alternative to corticosteroid use. Previous research has found that HRV-BF allows patients to take less asthma medication, while alleviating symptoms, improving pulmonary function, and preventing exacerbations Method. This is an interim analysis of data from an ongoing two-center trial. Eighteen subjects were assigned to a group receiving HR-BF, and 21 to a group receiving a combination of EEG alpha biofeedback, listening to relaxing music, and paced breathing at a relaxed rate (10-12 breaths/min) (EEG+). Training lasted approximately 4 months, with 6-10 sessions of training and assigned daily home practice. Subjects took daily morning and evening home peak flow measures on a Piko peak flow meter. We calculated the mean and standard deviation of daily AM peak flow values for approximately each month in the study. Fourteen subjects in HRV-BF and 7 in EEG+ had completed the last study week at the time these data were analyzed. Results. Preliminary data analysis showed a significant increase across both groups in peak expiratory flow mean and a decrease in standard deviation of peak expiratory flow values in both groups. However there were no differences between groups. Discussion. Results suggest that both our placebo and experimental conditions produced improvements in asthma condition. Paced breathing at a relaxed rate may help asthma as much as breathing at resonance frequency for measures of peak flow. Relationship with other variables may determine the pathways of action for each of the methods. 53 Deep brain stimulation and airway protection in Parkinson’s disease Michelle S. Troche, PhD/CCC-SLP,1 michi81@PHHP.UFL.EDU Karen W. Hegland, PhD/CCC-SLP,1 Alexandra E. Brandimore, MA/CCC-SLP,1 Michael Okun, MD,2 Paul W. Davenport, PhD3 1Department of Speech, Language, and Hearing Sciences University of Florida, Gainesville, FL, USA 2Department of Neurology and Neurosurgery University of Florida, Gainesville, FL, USA 3Department of Physiological Sciences University of Florida, Gainesville, FL, USA Background: Deep brain stimulation (DBS) surgery into the subthalamic nucleus (STN) and the globus pallidus interna (GPi) is quickly becoming the management option of choice for persons with Parkinson’s disease (PD). Despite this, the effects of DBS on swallowing and cough function are understudied, which is problematic given aspiration pneumonia is a leading cause of death in PD. The goal of this study was to compare the effects of STN vs. GPi DBS on swallowing and cough outcomes in PD. Method(s): Twenty-five participants with mild to moderate PD who were undergoing DBS were recruited for this study. Study procedures were completed before surgery and six months post-DBS surgery. Participants completed a capsaicin challenge with three randomized blocks of 0, 50, 100 & 200 μM capsaicin. Following each presentation, participants rated their UTC using a modified Borg scale. Sensitivity of the participant to the cough stimulus was measured as the log–log relationship of capsaicin concentration and UTC. Participants completed a videofluoroscopic evaluation of swallowing and swallowing safety was evaluated using the penetration-aspiration scale. Result(s): There was no significant difference in age, disease duration, or PD severity between STN and GPi DBS groups. Participants who received GPi DBS maintained swallowing safety outcomes, while participants who received STN DBS worsened. Preliminary results identified blunted UTC in the STN group as compared with the GPi group. These findings correlated with swallowing severity. Discussion: Understanding the differential effects of STN vs. GPi DBS on cough and swallowing outcomes provides interesting insight regarding the neural underpinnings of airway protection. Additionally, identifying the effects of DBS on airway protection is important and timely as DBS continues to develop as a primary management option; especially considering that aspiration pneumonia is a leading cause of morbidity and death in the PD population. 54 Symptom perception and affect: A theoretical account Omer Van den Bergh, PhD Omer.VandenBergh@ppw.kuleuven.be KU Leuven - University of Leuven, Health Psychology, Leuven, Belgium High trait negative affectivity (NA) persons tend to report symptoms that are poorly or unrelated to physiological dysfunction, both when healthy and ill. This relationship is also found, but less robustly, for high state NA. Most of the evidence on this relationship is correlational precluding interpretation of causal mechanisms. In the past decade, we have investigated this relationship in an experimental way through symptom inductions in the laboratory. We will present a review of studies and propose a simple set of assumptions about mechanistic processes that can account for most findings. We propose that high NA persons possess an over-reactive evaluative system leading to predominantly processing affectivemotivational aspects of a somatic experience at the expense of sensory-perceptual details. As a result, they develop somatic memory representations that are characterized by poor sensory-perceptual detail and are dominated by affective-motivational memory codes. Combined with deficient cognitive control, these assumptions are able to explain why and when high trait NA persons show poor correspondence between physiological dysfunction and self-reported symptoms, why they tend to be polysymptomatic and fail to show a normal retrospective bias (e.g. peak-end effect) in symptom reports, and why they are easily amenable to report symptoms in response to (associatively) learned and natural negative affective cues in the absence of physiological dysfunction. Clinical implications of this perspective are discussed. 55 Low end-tidal PCO2 across stress-related disorders: A transdiagnostic exploration of its correlates Maaike Van Den Houte, MA1 Maaike.VanDenHoute@ppw.kuleuven.be Katleen Bogaerts, PhD, 1 Lukas Van Oudenhove, PhD, 2 Ilse Van Diest, 1 PhD, Omer Van den Bergh, PhD1 1Health 2Clinical Psychology, University of Leuven, Leuven, Belgium and Experimental Medicine, University of Leuven, Leuven, Belgium Background. Low end-tidal PCO2 (PetCO2) and slow recovery from hyperventilation provocation is frequently observed in panic disorder. On the other hand, in respiratory medicine the term chronic hyperventilation is used to label patients with low PetCO2 and compromised recovery. Regardless of diagnostic controversies about differences and overlap, low PetCO2 may possibly be considered a transdiagnostic marker of psychophysiologic stress response occurring in a large variety of patients with stress-related disorders. The aim of this study was to explore possible correlates of PetCO 2 across different stress-related disorders. Method. A convenience sample of 106 outpatients with stress-related complaints, psychological disorders with a strong somatic component and functional disorders performed a capnography test (2-minute baseline; 5 deep sighs, 2-minute recovery; voluntary hyperventilation followed by 2 minutes of recovery). Patients filled out questionnaires measuring various personality variables, subjective physical complaints, psychiatric complaints and quality of life. Diagnostic information was available for 64 patients. Results. Mean baseline PetCO2 for the whole sample was low (34,93 mmHg, SD= 3,97 mmHg). Low baseline PetCO2 was associated with slower recovery from provocation, but not with recovery from sighing. Mean baseline PetCO2, PetCO2 right after challenge or recovery rates did not differ between diagnostic groups. None of the physiological measures correlated with trait questionnaires. Conclusion. As expected, low PetCO2 was associated with slower physiological recovery from voluntary hyperventilation. However, low levels of PetCO2 and slow recovery were not exclusively characteristic for patients suffering from panic disorder, nor was it associated with questionnaires measuring aspects of panic disorder. These results suggest that instead of being specific to panic disorder, low PetCO 2 and slow recovery might be a marker for stress-related disorders in general. Because of low sample sizes of the diagnostic groups, these data should be interpreted with caution. 56 Indirect regulation of breathing: a detour may be fastest Jan van Dixhoorn, MD, PhD dixhoorn@versatel.nl Centre for breathing Therapy Amersfoort and Research Center Linnaeus Institute, Haarlem Background. Direct breathing regulation implies a goal-directed strategy to change specific aspects of breathing: frequency, pauses, volume, ETCO2, resonance to heart rate, location etc. An alternative option is indirect regulation, which consists of strategies to modify determinants of breathing. The majority of instructions that we use are indirect forms of regulation. We use two main determinants: mental (direction of attentional focus) and mechanical (posture). The presentation will show how this is done and its effect on breathing movement and subjective sensation. Method. A recording was made of five experienced practitioners, executing a simple movement, while sitting on a flat, horizontal surface (a stool), looking straight ahead, feet in front of the knees, hands on the upper legs. They moved front and back a little, while focusing on the shift of weight in the sitting bones, for about one minute. Before and after, breathing movement was assessed manually (MARM) and subjective changes afterwards were noted. Results. The videos show an increased coordination between lumbar spine and chest bone, as well as improved balance of the head. Subjects noted to sit more firm and straight, to feel more freedom in the neck and more involvement of breathing in the chest. MARM showed an increase in the upper line (p<0.05) and a lesser decrease in the lower line (ns), resulting in a larger area of breathing movement. Discussion. An indirect procedure is a feasible option for breathing regulation. 57 Psychophysiological treatment of anxiety: does the diagnosis matter? Jan van Dixhoorn, MD, PhD1 dixhoorn@versatel.nl A Mataheru2, R Overbeek2, M Scheffers2 1Centre for breathing Therapy Amersfoort en Research Center Linnaeus Institute, Haarlem, The Netherlands 2 Windesheim College, Zwolle, The Netherlands Background. In experimental studies it has been shown that psychophysiological treatment can be effective in patients with anxiety disorder (Meuret, 2008) or with somatisation disorder (Katsamanis, 2011). In this observational study, we investigated whether patients with mainly anxiety complaints but without a DSM-IV diagnosis responded differently from patients with a DSM-IV diagnosis. Method. Patients with anxiety as their main complaint were selected from an existing database, containing subjects who were referred for breathing and relaxation therapy from 2006-2011. They were 255 subjects, 205 did not have a DSM-IV diagnosis (148 women, 57 men) and 50 subjects (36 women, 14 men) did. Outcome was assessed clinically (good effect, limited effect, no effect) and by way of two checklists, Nijmegen Questionnaire (NQ) and the General Distress Questionnaire (GDQ). Results. Good clinical effect was present in 52% of patients without diagnosis and in 37% of patients with diagnosis. Initial NQ scores were slightly higher for patients with diagnosis, statistically not significant, but initial GDQ scores were significantly higher. Both groups improved on both questionnaires, both highly significant (p<0.001). However, effect sizes were higher for patients without diagnosis (NQ: 1,0; GDQ: 1,0), than for those with diagnosis (NQ: 0,59; GDQ: 0,80). As a result the questionnaires normalized for more patients without diagnosis, than for those with diagnosis. Discussion. Although patients with DSM-IV diagnosis had higher scores and smaller reductions after treatment, the differences were relatively small and both groups did benefit significantly. Differences were greatest in general distress. 58 Resonance breathing affects hemodynamic oscillations in the brain at 0.1 Hz Evgeny Vaschillo, PhD1 evaschil@rci.rutgers.edu Jennifer F Buckman,PhD,1 Deena Peyser,BA,1 Sydney Heiss, 1 Peter Barnas, 1 Laura Banu,1 Alexander Puhalla,1 Bronya Vaschillo, MD,1 David Eddie,MS,1 Suchismita Ray, PhD,1 Stephen Hanson, PhD,2 Catherine Hanson, PhD,2 Bharat Biswal, PhD,3 Marsha E Bates, PhD1 1Center for Alcohol Studies, Rutgers – The State University of New Jersey, Piscataway, NJ, USA – The State University of New Jersey, Newark, NJ, USA 3New Jersey Institute of Technology, Newark, NJ, USA 2Rutgers Background: The positive effects of resonance breathing (0.1 Hz; ~6 breaths-per-minute [6P]) on cardiovascular functions and clinical symptoms have been well-documented, yet little is known about functional brain responses during resonance breathing. The present study investigated hemodynamic oscillation in the whole brain during 6P by simultaneously assessing electrocardiogram (ECG), respiration, and the BOLD response using functional magnetic resonance imaging (fMRI). Methods: Participants (n = 22, 9 females, ages 18-25) completed two 5-minute tasks: a baseline task and a 6P breathing task in a 3T Siemens Trio scanner. During baseline, participants completed a low-demand task. During 6P, participants breathed at a rate of approximately 0.1 Hz by following a visual pacer. ECG and respiration data were collected using Biopac MRI-compatible ECG electrodes and thoracic breath belt. Time series fMRI BOLD data were extracted using FSL 5.0.5. Power spectra were estimated using a Fourier transformation in WinCPRS (Absolute Aliens Oy, Finland). Results: During the baseline task, there was substantial variability between participants in the power spectra of hemodynamic oscillations in the brain. During the 6P task, robust peaks were observed at 0.1 Hz in the brain stem and cerebellum. Peaks at 0.1 Hz were also observed for most participants in the amygdala, and anterior cingulate, frontal medial, and insular cortices during 6P. In addition, one participant who did not perform 6P properly also did not demonstrate any discernible resonance breathing effects in these brain regions. Discussion: We observed hemodynamic oscillations at 0.1 Hz in multiple brain regions during resonance breathing. These data provide the first step towards better understanding how respiration affects brain hemodynamics and how resonance breathing potentially may contribute to positive clinical outcomes. 59 Sigh to restore respiratory variability. proposed mechanism. Evgeny Vaschillo, PhD evaschil@rci.rutgers.edu Bronya Vaschillo, MD, Jennifer Buckman, PhD, Sydney Heiss, Marsha Bates, PhD Center of Alcohol Studies, Rutgers University, New Jersey, USA Background: Prior studies showed that a sigh is a respiratory maneuver associated with stressful events, negative emotions, unpleasant thoughts, as well as with cognitive loading and sustained attention. Vlemincx and colleagues (2010 – 2013) found that a sigh can restore the structure of respiratory variability after disruption by psychological strain and hypothesized that normalization of respiration reduces stress and counteracts emotionality. The present study builds on these findings by suggesting a mechanism by which sighing restores respiratory variability. Method: ECG, respiration, and beat-to-beat blood pressure were collected in 24 young healthy participants during a baseline, 0.1 Hz paced breathing, and 0.02 Hz paced sighing (10 sighs, 1 sigh/50 seconds, with normal breathing interspersed) tasks. Results: Each sigh induced a powerful, but temporally constrained effect on blood pressure (BP), RRI, and pulse transit time (PTT, a measure of vascular tone) that gradually faded over ~50 s. Each sigh provoked an average change of 14.5(1.4) mmHg in systolic BP, 7.3(0.4) mmHg in diastolic BP, 106.9(12.4) ms in RRI, and 8.7(1.0) ms in PTT. Discussion: The affected cardiovascular functions are known to participate in homeostatic processes that control stress and emotions through the baroreflex. We suggest that the observed changes in BP, RRI, and PTT induced by a sigh occur due to activation of the afferent neural outflow from the baroreceptors. This afferent traffic serves as a broad inhibitory force on subcortical and cortical processing and, as such, can mitigate emotional and psychological strain. These results thus provide preliminary evidence that a sigh’s ability to “reset” the respiratory system is provided by the baroreflex mechanism. According to this hypothesis, a sigh alters cardiovascular functions, which activate the afferent stream of the baroreflex. This afferent activation promotes neural inhibition to reduce stress and emotional arousal. This psychological benefit then serves to restore respiratory variability. 60 Asthma triggers in Latino adults with comorbid asthma and panic disorder Karinna Vazquez, MA kvazquez427@gmail.com Jonathan Feldman, PhD Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA Background: Asthma has been linked to a higher prevalence of panic disorder (Carr, Lehrer, & Hochron, 1992; Carr, Lehrer, Rausch, & Hochron, 1994) and this comorbidity occurs more often in Latinos than in other ethnic groups (Dumanovsky & Matte, 2007; Lehrer, Feldman, Giardino, Song, & Schmaling, 2002; Rose, Mannino, & Leaderer, 2006). The aim of the current study was to examine differences in asthma triggers between Latino asthma patients with panic disorder versus Latino asthma patients without panic disorder. It was expected that Latino asthma patients with panic disorder would endorse a higher frequency of asthma triggers than those without panic disorder. Methods: Participants in this study included 302 (227 English-speaking and 75 Spanish-speaking) selfreported, adult asthma patients of Latino descent who were screened to assess eligibility for the asthma and panic disorder treatment study. This study examined asthma triggers using the Asthma Trigger Inventory (ATI), a structured, self-report instrument for the assessment of asthma triggers (Ritz, Steptoe, Bobb, Harris, & Edwards, 2006). The PRIME-MD Patient Health Questionnaire (PHQ): Panic Screening Questions was used to assess if participants exhibited panic disorder symptoms. The Structured Clinical Interview for DSM-IV (SCID-I) and the Panic Disorder Severity Scale (PDSS) were used to confirm the diagnosis and assess the severity of panic disorder. Results: The results showed that participants with panic disorder reported a significantly higher frequency of psychological, physical activity, pollutant, and infection asthma triggers than participants without panic disorder controlling for age, gender, and language of interview. The results also found that participants with panic disorder reported a significantly higher impact of asthma triggers on their daily functioning than participants without panic disorder. Discussion: The findings suggest that asthma triggers may have a greater impact on Latino asthma patients with panic disorder than Latino asthma patients without panic disorder. Interventions can be developed to help patients learn how to avoid or control triggers that have a higher prevalence in Latino asthma patients with panic disorder. 61 The effect of sighs on self-reported relief and physiological muscle tension Elke Vlemincx, PhD elke.vlemincx@ppw.kuleuven.be Ilse Van Diest, PhD, Omer Van den Bergh, PhD Research Group on Health Psychology, University of Leuven Background. Research in both animals and humans has shown an important correlation between sighs and relief. However, the proposed resetting properties of sighs suggest that sighs cause relief. The current experiment aimed to compare the causal effect of sighs versus breath holds on psychological and physiological relief. Method. A previously established paradigm alternating transitions to certain safety (predicting that no aversive stimulus would occur) with transitions to danger (predicting that an aversive stimulus would occur) was used, which has been shown to increase spontaneous sigh rates. Three blocks of 40 trials were presented. In the first block, no breathing instructions were given. In Blocks 2 and 3, participants (N=35) were instructed to either take a deep breath (‘sigh’) or to postpone their next inspiration for two seconds ('breath hold') during transitions in 20 trials. Continuously, surface electromyography of the Frontalis was measured and participants rated how relieved they felt using a dial. Self-reported relief and physiological tension were compared five seconds before and after each sigh (defined as a breath in the ‘sigh’ block with a volume at least twice as large as the mean volume during Block 1) and each breath hold (defined as a breath in the ‘breath hold’ block with an expiratory pause longer than two seconds which was not a sigh). Results. Results show that (1) self-reported relief following a sigh was higher than before a sigh, (2) selfreported relief following a sigh was higher than following a breath hold, and (3) self-reported relief did not change before and after breath holds. In addition, physiological tension decreased following a sigh, but did not decrease following a breath hold. Discussion. These results suggest that a sigh relieves, both psychologically and physiologically, and therefore support the hypothesis that sighs function as psychological and physiological resetters. 62 Neural processing of short-term habituation and sensitization to dyspnea Andreas von Leupoldt, PhD 1,2 andreas.vonleupoldt@ppw.kuleuven.be Roland W Esser 2, MMatthias Gamer 2, Christian Büchel2, Maria Cornelia Stoeckel2 1 Research Group Health Psychology, University of Leuven, Leuven, Belgium of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany 2Department Background Both habituation and sensitization to dyspnea might impact the course of the underlying disease. This study examined neural processes involved in short-term habituation and sensitization to experimentally induced dyspnea. Methods Forty six healthy volunteers underwent twenty blocks of inspiratory resistive loaded breathing with parallel acquisition of fMRI-data. We alternately presented loads inducing severe dyspnea (dyspnea condition) and loads that were just noticeable (baseline condition). Each condition was cued for 6s (anticipation period) and lasted 24s (dyspnea period). After each block ratings of dyspnea intensity and unpleasantness were obtained. We compared data from the second (“late”) half with data from the first (“early”) half of the experiment. Results Approximately two thirds of the volunteers showed increased intensity and/or unpleasantness ratings (indicating “sensitization”) during the second half of the experiment as compared to the first half. The remaining third showed similar or decreased ratings (indicating “habituation”). For the anticipation period, we observed a significant negative correlation of delta intensity and unpleasantness ratings with the late vs. early [cue dyspnea vs. cue baseline] contrast in the periaqueductal gray (PAG). A positive correlation of delta unpleasantness ratings was found with bilateral anterior insula. For the dyspnea period, we observed a negative correlation of delta intensity and unpleasantness ratings with the late vs. early [dyspnea vs. baseline] contrast in the rostral anterior cingulate cortex (rACC). A positive correlation of delta unpleasantness ratings was found with right anterior insula. Discussion An increasing recruitment of PAG and rACC during the anticipation (PAG) and perception (rACC) of dyspnea seems to result in short-term habituation in perceived intensity and unpleasantness of dyspnea. In contrast, an increasing recruitment of anterior insula during the anticipation and perception of dyspnea seems to underlie a short-term sensitization process that is limited to the perceived affective unpleasantness of dyspnea. 63 How is breathlessness remembered by patients with Medically Unexplained Dyspnea? Marta Walentynowicz, MA1 Marta.Walentynowicz@ppw.kuleuven.be Katleen Bogaerts, PhD,1 Linda Stans, MA,3 Ilse Van Diest, PhD,1 Filip Raes, PhD,2 Omer Van den Bergh, PhD1 1Health Psychology, University of Leuven, Leuven, Belgium and Experimental Psychopathology, University of Leuven, Leuven, Belgium 3Pneumology Department, University Hospital Gasthuisberg, University of Leuven, Belgium. 2 Learning Background. Retrospective reports of breathlessness serve as an important source of information for clinicians. Several biases may influence memory for symptoms, but little information exists on how breathlessness episodes are encoded and remembered by persons reporting breathlessness unrelated to physiological dysfunction. In the present study we investigated whether memory for experimentally induced breathlessness episodes in patients with medically unexplained dyspnea (MUD) differed from that of matched healthy controls. Method Female MUD patients (N=22) and matched healthy controls (N=22) participated in two trials of a rebreathing paradigm, resulting in a progressive increase in PCO2, ventilation and breathlessness. Order of the trials was counterbalanced across participants. Dyspnea ratings were collected at three moments: (1) continuously during symptom induction, (2) after the experiment, (3) after 2 weeks. Respiratory parameters were measured continuously during the trials. State NA, PA and anxiety were evaluated at baseline and after every trial. Results Both rebreathing trials resulted in higher concurrent dyspnea ratings as well as increased minute ventilation among patients compared to controls. Retrospective overestimation (compared to concurrent measurement) was observed in both groups. However, no increase in overestimation was observed across a two week time frame and no interaction with Group was found. Compared to baseline ratings, dyspnea induction resulted in higher anxiety and lower PA ratings in the patient group, while state NA remained on similar level. Discussion The findings show that retrospective dyspnea reports are biased in a similar way in both patients and healthy controls. Since overreporting in the patient group was found across all measurement occasions, starting from online ratings, it suggests that biases in that group may operate predominantly during symptom perception/memory encoding. Those findings, together with the lack of increase in overestimation over time, could inform future clinical interventions tackling symptom overestimation. 64 Retrospective memory for breathlessness and pain. Marta Walentynowicz, MA1 Marta.Walentynowicz@ppw.kuleuven.be Ilse Van Diest, PhD,1 Filip Raes, PhD,2 Omer Van den Bergh, PhD1 1Health Psychology, University of Leuven, Leuven, Belgium and Experimental Psychopathology, University of Leuven, Leuven, Belgium 2Learning Background. Patient reports and questionnaire data on symptoms mostly rely on retrospective memory. Comparisons of concurrent (through experience sampling) and retrospective reports typically have no control over actual experiences. Also, individual differences in retrospective symptom reporting after experimental symptom inductions have not been systematically investigated. In the present study, we investigated retrospective memory for two experimentally induced symptoms, namely breathlessness and pain, in high (HSR) and low habitual symptom reporters (LSR). Method. Healthy women (N=48; 24HSR/24LSR) participated in (a) two trials of a rebreathing paradigm, leading to a gradual increase in PCO2, ventilation and breathlessness, and (b) two trials of a modified cold pressor task. Dyspnea and pain inductions were administered in two separate sessions and participants were counterbalanced across eight trial orders. Dyspnea and pain ratings were collected at four times: (1) continuously during symptom induction, (2) after each trial, (3) after the experiment, and (4) after 2 weeks. State NA and state anxiety were measured after every trial. Results. Dyspnea induction resulted in higher state NA and anxiety than pain induction. Retrospective evaluations were overall higher than concurrent evaluations, but differences between dyspnea and pain emerged. While retrospective dyspnea ratings were equally overestimated by both groups, the recalled pain ratings were higher in HSR than in LSR. Moreover, a further increase in overestimation over time was only found for breathlessness ratings in HSR. Discussion. Our results show that even though retrospective evaluations of both breathlessness and pain are distorted, the type of bias clearly differs between the symptoms. The findings suggest the relevance of unpleasantness of the experience for memory processes, such that in less aversive inductions individual differences play a more pronounced role. Moreover, the observed increase of dyspnea overestimation over time is important for diagnostic assessment based on symptom reporting. 65 The influence of respiratory dynamics on relaxation and cardiorespiratory parameters and the response to and recovery from mental stress. Ruth Wuyts, MA ruth.wuyts@ppw.kuleuven.be Elke Vlemincx, PhD, Ilse Van Diest, PhD, Omer Van den Bergh, PhD Health Psychology, University of Leuven, Leuven, Belgium Background. Whereas slow and regular breathing instructions are often included in relaxation training, the clinically validated effects of breathing techniques on various stress-related disorders are not well understood. From a dynamic systems perspective, healthy breathing is characterized by complex variability balancing correlated and random variability components, while a lack of structured variability or too much random variability is indicative of unhealthy breathing and decreased system sensitivity to changing environmental demands. In this study we investigated the effect of slow regular and normal regular breathing on subjective relaxation, cardiorespiratory parameters and physiological stressreactivity. Methods. A slow regular (8 bpm) and normal regular (14 bpm) breathing pattern was induced in each subject (N = 23) by means of auditory pacing. Respiratory and cardiovascular parameters were continuously recorded using the LifeShirt System. After each breathing pattern a mental stressor was introduced followed by a recovery period. Subjective relaxation in response to the breathing patterns was assessed, and total respiratory variability and structured variability of respiratory parameters were indexed by the coefficient of variation (CV) and autocorrelation (AR) respectively. Cardiorespiratory parameters were assessed in response to and recovery of the mental stressor. Results. Mean respiratory rate (RR) showed pacing was successful. Subjective relaxation was higher during slow regular breathing then during normal regular breathing. Structured variability of RR decreased during both breathing exercises, and this was not compensated by increased structured variability in respiratory volume parameters. Changes in parameters of respiratory variability and heart-rate-variability in response to the stressor and recovery thereof will be further addressed. Discussion. Whereas slow regular breathing increased subjective relaxation, both breathing exercises did not promote healthy breathing. Further results will help to resolve conflicting conceptions about healthy breathing and treatment practices. 66

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