Capnometry-assisted respiratory training (Meuret; Freespira)

Domain IX · Biomedical, neuro & digital · Alicia Meuret, Wilhelm, Roth · 2001 · Stanford, USA / Hamburg, Germany

What it is

CART is a short respiratory biofeedback treatment. A portable capnometer samples exhaled air through a nasal cannula and shows the person, breath by breath, their respiratory rate and end-tidal CO2 (the CO2 level at the end of each out-breath). The core idea: many people with panic disorder breathe…

Format

• Format: five individual sessions over about four weeks, each about 80 minutes, from a written manual; the client receives a portable capnometer and a therapy manual for home use.
• Session 1 (rationale and skill acquisition): review of the client's own recordings; explanation of a hyperventilation-based model linking fast, deep or irregular breathing to symptoms; teaching slow diaphragmatic breathing lying and sitting; paced breathing to audio tones while watching the…

Who practises it, and how they are trained or regulated

• Referral and authorisation: the device is prescription-use under FDA labelling. The DTx Alliance profile states that authorisation from a licensed healthcare provider is required, not necessarily a physician's prescription, and that patients can self-refer through the company or be referred by a provider.
• Training visit: the client is trained on the sensor, cannula and tablet and completes a first session with the trainer.
• Outside the US: no CE/UKCA marking, NICE assessment or other non-US regulatory status was found in the cited sources.

Evidence status, as the guide reports it

• Meuret et al. (2008) randomised 37 people with panic disorder to the breathing therapy or a delayed-treatment control and reported improvements in panic severity, avoidance, anxiety sensitivity, disability and respiratory measures, maintained at 12 months; the authors call the benefit preliminary…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• using breathing to escape a situation rather than stay in it.
• return of symptoms at follow-up: offer a booster review or further treatment.
• blank or retrospectively filled logs; look for patterns between low-CO2 days and anxious days.
• clients who 'try hard' and breathe more deeply, which can lower CO2; the readings show this immediately.
• breathing skills turning into a safety behaviour during exposure work; discuss it openly and adjust together.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.