Hyperventilation and fear of going crazy

A couple of thoughts:

Depersonalization and derealization can be created or exacerbated by chronic and/or acute hyperventilation. Some clients may benefit from the proper kind of breathing re-training. Some work at Stanford has shown that simply teaching slower, diaphragmatic breathing is not enough for symptoms to remit. Subjects tend to increase tidal volume to offset the lower bpm. They have developed a very promising protocol using a capnometer (measuring exhaled pCO2) as a feedback device.

In terms of panic, depersonalization and derealization are the sx's most often misinterpreted as signs of impending insanity. A thorough program of psychoeducation and interoceptive exposure can be very helpful in decastrophizing these states. Two techniques for inducing the sx's for desensitization are:

1) Intentional hyperventilation
2) Staring into a mirror

Carl Robbins, LCPC
Anxiety and Stress Disorders Institute of Maryland

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