Home›Psychiatry› Maximal voluntary breath-holding time identifies shorter interoceptive tolerance in patients with panic disorder
Maximal voluntary breath-holding time identifies shorter interoceptive tolerance in patients with panic disorderBreath Holding Time May Help Identify Panic Disorder Symptoms
Biological psychologyPublished September 1, 2026Study authors: Puigcerver Maragda, Serrano Miguel ÁngelPubMed ↗DOI ↗Editorial oversight: Dr. Ji-eun Park, MD · Brain, Mind & Pain
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Key Takeaway
Note that mvBHT serves as a reliable marker to distinguish clinical anxiety groups and track state anxiety levels.
This meta-analysis evaluated the utility of maximal voluntary breath-holding time (mvBHT) as a performance-based marker of interoceptive tolerance in adults with anxiety disorders compared to healthy controls. The analysis included 1263 participants across various anxiety conditions.
Key findings indicate that individuals with anxiety disorders exhibited shorter mvBHT than healthy controls. Specifically, a medium-sized reduction in mvBHT was observed in panic disorder. While mvBHT showed smaller, non-significant effects in non-panic anxiety disorders and marginal associations with trait anxiety, it showed significant and consistently stronger associations with state anxiety and momentary distress.
Moderating factors were also identified. In healthy controls, a higher proportion of females predicted shorter mean mvBHT, and protocols initiating breath-hold after inhalation yielded longer mvBHT than those after exhalation. In panic disorder, sex composition did not predict mvBHT, but breath-hold onset was a primary study-level predictor.
Clinically, mvBHT may serve as a reliable tool to distinguish clinical from non-clinical groups and track state anxiety and distress. However, the evidence is limited by the lack of reported p-values, confidence intervals, and specific study limitations in the source data.
How this fits prior evidence
This meta-analysis addresses a gap in identifying objective markers for interoceptive tolerance. It complements existing evidence regarding panic disorder, such as the observation that panic disorder symptoms decreased during guideline-based pharmacotherapy. While pharmacotherapy addresses symptoms, mvBHT may provide a performance-based marker to track state anxiety and distress in these populations.
Researchers analyzed data from 1,263 participants to see if the maximum voluntary breath-holding time (mvBHT) could serve as a marker for how people handle internal physical sensations. The study compared adults with anxiety and panic disorders against a group of healthy individuals.
The results showed that people with panic disorder had significantly shorter breath-holding times than the healthy group. While the difference was less clear for other types of anxiety disorders, the study found a strong link between breath-holding time and a person's immediate feelings of distress and state anxiety.
Because this is a meta-analysis of existing data, it is important to note that while breath-holding time can distinguish between clinical and non-clinical groups, it is not a definitive test for a condition. It is a tool that may help researchers understand how patients experience physical sensations. You should talk to a healthcare provider to discuss these findings and how they relate to your specific health needs.
What this means for you:
Shorter breath-holding times are linked to panic disorder and can track a person's immediate feelings of distress.
Common questions
What did the study find about breath-holding and panic disorder?
The study found that individuals with panic disorder had a medium-sized reduction in their maximum voluntary breath-holding time compared to healthy controls. This suggests that breath-holding time can reliably distinguish between clinical and non-clinical groups.
Can breath-holding time tell you how anxious a person feels right now?
Yes, the study found significant and consistently stronger associations between breath-holding time and state anxiety as well as momentary distress. This means the measurement may track how a person feels in the moment.
Is this a definitive way to diagnose anxiety?
No, this study shows a link between breath-holding and distress, but it is not a replacement for a medical diagnosis. You should consult a doctor or mental health professional to discuss your symptoms and treatment options.
Altered interoceptive processing and reduced tolerance to aversive bodily sensations are core features of anxiety disorders. Maximal voluntary breath-holding time (mvBHT) has been proposed as a simple, objective behavioral index of interoceptive tolerance. This PRISMA-guided systematic review and meta-analysis evaluated mvBHT as a performance-based marker of interoceptive tolerance in anxiety by examining whether this measure differentiates adults with anxiety disorders (AD) from healthy controls (HC), quantifying its associations with trait and state anxiety, and examining study-level moderators (sex, age, and breath-hold onset). 22 studies (N = 1263 adults) were included. Random-effects models showed that AD exhibited shorter mvBHT than HC, an effect driven by a significant medium-sized reduction in panic disorder (PD) with low heterogeneity, whereas non-PD anxiety disorders yielded a smaller, nonsignificant effect. Multilevel meta-analytic correlations indicated marginal, non-significant associations between mvBHT and trait anxiety once within-study dependence was accounted for, whereas associations with state anxiety and momentary distress assessed during or immediately after respiratory challenge were significant and consistently stronger. Meta-regressions in HC samples indicated that a higher proportion of females predicted shorter mean mvBHT, and that protocols initiating the breath-hold after inhalation yielded longer mvBHT than those initiating after exhalation. In PD samples, sex composition did not predict mvBHT, whereas breath-hold onset remained the primary study-level predictor. Overall, mvBHT reliably distinguishes clinical from non-clinical groups and tracks state anxiety and distress; trait correlations are marginal and non-significant once within-study dependence is properly modelled, supporting its utility as a performance-based behavioral marker of respiratory interoceptive tolerance.
