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The use of Biofeedback in Clinical Virtual Reality: The INTREPID Project

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Mobile App-Guided Exposure Therapy for Panic Disorder With and Without Agoraphobia: Randomized Controlled Trial.

Matthias Guth¹, Annika Wiebe¹, Mogda Ekhlas-Schumann¹

¹Department of Psychiatry and Psychotherapy, University Hospital Bonn, Venusberg-Campus 1, Bonn, 53127, Germany, +49-228-287-15723.

Journal of Medical Internet Research

|November 19, 2025

Summary

A mobile app delivering exposure therapy significantly reduced panic disorder and agoraphobia symptoms compared to a waiting list. This digital tool shows promise as an additional treatment option for panic disorder (PD) and agoraphobia.

Keywords:

agoraphobia digital health exposure therapy mobile health mobile intervention panic disorder

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Area of Science:

Digital Health
Psychotherapy Research
Clinical Psychology

Background:

Mobile apps offer novel therapeutic tools for panic disorder (PD) and agoraphobia, usable in real-life symptom-triggering situations.
Existing evidence for mobile interventions in PD is limited, necessitating further research.

Purpose of the Study:

To evaluate the efficacy of a mobile app focused on interoceptive and in-vivo exposure therapy for PD with and without agoraphobia.
To expand the evidence base for mobile interventions in treating PD and agoraphobia.

Main Methods:

A randomized controlled trial involving 111 adults diagnosed with PD with or without agoraphobia.
Participants were randomized into three groups: exposure therapy app, a mindfulness meditation app (active control), and a waiting list (passive control).
Primary outcome was self-reported symptom severity measured by the Panic and Agoraphobia Scale; secondary outcomes included depressive symptoms and quality of life.

Main Results:

The exposure app group showed significantly lower PD and agoraphobia symptom severity compared to the waiting list group post-treatment and at follow-up.
Significant improvements in depressive symptoms and quality of life were observed in the exposure app group versus the waiting list group at follow-up.
No significant differences in symptom severity were found between the exposure app and the meditation app groups.

Conclusions:

App-guided exposure therapy presents a viable supplementary treatment option for PD and agoraphobia.
The superiority of the exposure app over a disorder-unspecific meditation app requires further investigation.
A notable percentage of participants using the exposure app achieved reliable improvement in symptoms.