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Thomas
Ritz, Ph.D. |
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Research interests |
• Respiratory Psychophysiology: Lung Function in Health and
Disease |
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Respiratory psychophysiology: Lung function in health and disease
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It is well known that breathing can be modified voluntarily, although the extent of influences by the ongoing behavioral process remains to be explored. Less well known is the fact that the smooth muscles of the airways can be influenced by psychological processes through changes in autonomic nervous system outflow, in particular by vagal activity, and/or changes in breathing. This is particularly important for patients with respiratory diseases, as their lung function may be compromised through such pathways. In recent years I have been intrigued by these influences and tried to characterize their nature and extent. In collaboration with teams at the University of Hamburg (Bernhard Dahme), University of London (Andrew Steptoe), and Stanford University (Walton T. Roth) I have used a variety of experimental emotion induction techniques to study their effect on the airways. The challenge of the coming years will be to integrate these findings into a wider framework of a biopsychosocial view of the asthmatic disease process. This will include the exploration of psychological influences on airway inflammation. We are currently using noninvasive methods such as exhaled nitric oxide measurements to study allergic inflammation in the context of psychophysiological research.
Representative Publications Ritz, T., Thöns, M., Fahrenkrug, S., & Dahme, B. (2005). The airways, respiration, and respiratory sinus arrhythmia during picture viewing. Psychophysiology, 42, 568-578. Ritz, T. (2004). Probing the psychophysiology of the airways. Physical activity, experienced emotion, and facially expressed emotion. Psychophysiology. 41, 809-821 Ritz, T., Dahme, B., DuBois, A.B., Folgering, H. Fritz, G.K., Harver A.R., Kotses, H., Lehrer, P.M., Ring, C., Steptoe, A., & Van de Woestijne, K.P. (2002). Guidelines for mechanical lung function measurements in psychophysiology. Psychophysiology, 39, 546-567 Ritz, T. & Steptoe, A. (2000) Emotion and pulmonary function in asthma: Reactivity in the field and relationship with laboratory induction of emotion. Psychosomatic Medicine, 62, 808-815. Ritz, T., Steptoe, A., De Wilde, S. & Costa, M. (2000). Emotions and stress increase respiratory resistance in asthma. Psychosomatic Medicine, 62, 401-412.
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Behavioral Medicine of Respiratory Disease
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The behavioral medicine of asthma often defies comfortable lay theories, such as “relaxation is good for your asthma”. Substantial research shows that activating the skeletal muscles is more likely to open up the airway passages than relaxing the muscles. Consequently, research on relaxation techniques has only produced mixed results in asthma patients. Surprisingly little systematic research is available on the psychophysiological mechanisms and the efficacy of various adjunctive behavioral intervention techniques in respiratory disease. Among the more promising techniques for asthma are methods that modify habitual breathing patterns. In collaboration with Alicia E. Meuret, faculty member at the Department of Psychology of SMU, and Walton T. Roth, Stanford University, we have recently designed and successfully piloted a biofeedback-assisted breathing technique to alter carbon-dioxide levels in the blood of patients, which are typically low when they hyperventilate. Hyperventilation is known to have adverse effects on the airways in asthma, and breathing training to reduce it could be a promising adjunctive intervention. Targeting perceptions of illness is another important area in behavioral medicine. These perceptions can determine how illness is being treated or managed. We found that brief education on asthma trigger avoidance can improve asthma control in primary care patients. A randomized control trial is underway in collaboration with nurse practitioners and primary care researchers in London, UK (Carol Bobb, Chris Griffiths, and Gillian Rowland) to evaluate the efficacy of this intervention in a larger patient sample. Representative Publications Meuret, A.E., Ritz, T. & Roth, W.T. (2007) Targeting pCO2 levels in asthma: Pilot evaluation of a capnometry-assisted breathing training. Applied Psychophysiology and Biofeedback, 32, 99-109. Ritz, T., Steptoe, A., Bobb, C., Harris, A., & Edwards, M. (2006). The Asthma Trigger Inventory: Development and evaluation of a questionnaire measuring perceived triggers of asthma. Psychosomatic Medicine, 68, 617-627. Ritz, T. & Roth, W.T. (2003). Behavioral interventions in asthma: Breathing training. Behavior Modification, 27, 710-730. Bobb, C. & Ritz, T. (2003). Do asthma patients in general practice profit from a structured allergen evaluation and skin prick testing? A pilot study. Respiratory Medicine, 97, 1180-1187. Ritz, T. (2001). Relaxation therapy in asthma: Is there new evidence for its effectiveness? Behavior Modification, 25, 640-666.
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Noninvasive Measurement of Vagal Function
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The parasympathetic branch of the autonomic nervous system helps coordinate important restorative functions for the organism. Following extensive research on stress and sympathetic function in psychology researcher in recent years have begun to study the role of the parasympathetic system in emotion and health. Respiratory sinus arrhythmia (RSA), the fluctuations of heart rate during breathing, have been used as a convenient noninvasive window into cardiac vagal activity, an index of parasympathetic activation. We have studied issues in the measurement of RSA, in particular the control of respiratory parameters in interpreting RSA, and we have tested techniques of experimentally inducing vagal excitation using facial cold stimulation. Also, we have investigated the role of vagal activity in the emotional process using stimulation with affective pictures.
Representative Publications Ritz, T. & Dahme, B. (2006) Implementation and interpretation of heart rate variability measures in psychosomatic medicine: Practice against better evidence? Psychosomatic Medicine, 68, 617-627. Ritz, T., Thöns, M. & Dahme, B. (2001) Modulation of respiratory sinus arrhythmia by respiration rate and volume: Stability across postures and volume variations. Psychophysiology, 38, 858-862. Ritz, T., Thöns, M. & Dahme, B. (2000). Increases in total respiratory resistance during forehead temperature stimulation. Biological Psychology, 50, 119-135.
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Anxiety disorders, depression, and respiratory disease
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Psychophysiological response patterns in psychological disorders can sometimes have similarities with those in respiratory disease under conditions of psychological challenge. Blood phobia sometimes show strong vagal excitation when exposed to blood, injury or injection-related stimuli, and vagal excitation is also thought to be the main mechanism behind emotion-induced airway obstructions in asthma. Hyperventilation is a habitual response pattern which is common to anxiety patients in feared situations and is also common in asthma patients. There are also suggestions that autonomic and endocrine dysregulation in depression can negatively impact on respiratory disease. The prevalence of depression and anxiety disorders, in particular panic, tends to be higher in patients with respiratory disease, and this can lead to reciprocal complications in the treatment of these diseases. Research comparing psychophysiological response patterns and their characteristic elicitors across disorders can advance our basic understanding of these disorders and inform treatment approaches. Representative Publications Kullowatz, A., Kanniess, F. Dahme, B., Magnussen, H., & Ritz, T. (2007). Association of depression and anxiety with health care use and quality of life in asthma. Respiratory Medicine, 101, 638-644. Ritz, T., Wilhelm, Kullowatz, A., Gerlach, A. & Roth, W.T. (2005). End-tidal PCO2-levels in blood phobia during viewing of emotional and disease-relevant films. Psychosomatic Medicine, 67, 661-668. Meuret, A.E., Ehrenreich, J.T., Pincus, D.B., & Ritz, T. (2006) Prevalence and correlates of asthma in children with internalizing psychopathology. Depression and Anxiety, 23, 502-508. Meuret, A.E., Ritz, T., Wilhelm, F.H., & Roth, W.T. (2005). Voluntary hyperventilation in the treatment of panic disorder - functions of hyperventilation, their implications for breathing training, and recommendations for standardization. Clinical Psychology Review, 25, 285-306. Ritz, T., Wilhelm, F.H., Meuret, A.E., Gerlach, A. & Roth, W.T. (2005). Airway response to emotion- and disease-specific films in asthma, blood phobia, and health. Psychophysiology, 42, S105 |
