Feasibility of using Virtual Reality in Patients with Panic Disorder: An Experimental Crossover Study Protocol

Vollständiger Abstract

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Introduction Virtual reality (VR) is a promising tool for diagnosis and therapy in Panic Disorder (PD), allowing controlled exposure to anxiety-provoking situations and real-time assessment of behaviors and physiological responses. Studies indicate its effectiveness in reducing symptoms and its therapeutic applicability. However, there is a lack of robust data on its specific impact on heart rate variability (HRV), sense of presence, safety, and acceptability in patients with PD and agoraphobia. Therefore, further research is warranted to evaluate these aspects, aiming for a broader understanding and optimization of this technology in mental health. Objective Thus, this experimental crossover study protocol aims to evaluate the sense of presence, method safety, acceptability, psychological ( i.e. , anxiety), and physiological changes ( i.e. , respiratory and heart rate, HRV, tidal volume and respiratory minute volume, and level of skin conductance). In addition, correlate the psychological measures with the physiological ones. Methodology This is an experimental crossover study protocol, following an within-subject crossover design, with independent groups (between-subjects), in which 25 PD patients and 25 controls will be randomly allocated, through block randomization to an experimental group (PD patients) and a control group (healthy individuals) where they will go through the following sequences: (1) initial exposure to 2D video, using projection glasses, followed by the same scene in VR with the Oculus 2 headset; or (2) initial exposure in VR, followed by the 2D video. VR offers an ecological and multimodal method for assessment, aligned with initiatives such as RDoC. The protocol, structured in modules that reflect components of Cognitive-Behavioral Therapy, aims to test the system's ability to respond to clinically relevant anxiety in a safe and acceptable manner. Results The results of the trial will be published in international peer-reviewed journals and will be disseminated at international meetings and congresses. Discussion Potential contributions include a more objective and standardized assessment, useful for personalizing interventions. Limitations such as sample size and ecological validity are acknowledged. Conclusion In conclusion, the protocol represents a methodological advancement. The results of this predictive study will be crucial for refining the technology and informing future clinical trials, with the potential to improve diagnostic accuracy and optimize personalized therapeutic strategies for PD.