May 27 2013
A number of studies have demonstrated the efficacy of virtual reality exposure therapy (VRET) in specific phobias, but research in
seriously impaired patients with agoraphobia is lacking.
In this randomized controlled trial with patients with agoraphobia and panic disorder, VRET and
exposure in vivo were compared in terms of outcome and processes involved.
Patients with panic disorder with agoraphobia (n = 55) were randomly assigned
to receive 4 sessions of cognitive behavioral therapy (CBT) followed by either 6 sessions of VRET or 6 sessions of exposure in vivo or to a waiting list control condition.
Analyses showed that both active treatment packages were
significantly more effective than no treatment and that no differences between
VRET and exposure in vivo were found in three out of four outcome measures.
On the panic disorder severity scale, however, CBT plus exposure in vivo was more
effective than CBT plus VRET. The results show clear synchrony of temporal
processes involved in VRET and exposure in vivo on weekly avoidance measures
and cognitive measures.
Further, it was shown that initial changes in agoraphobic cognitions during the CBT phase predicted later changes in agoraphobic avoidance behavior.
These data support the notion that therapeutic processes involved might be the same in VRET and exposure in vivo. However,
given the slight superiority of exposure in vivo above VRET, the costs involved
in the implementation of VRET and the lack of long-term follow-up, VRET cannot
yet be recommended for patients with agoraphobia.