Comparisons of Virtual Reality-based vs. Conventional Biofeedback for Panic Symptoms: A Randomized Controlled Study

Virtual reality (VR)-based biofeedback (BF) is being studied as a new type of treatment in the field of psychiatry. We explored the potential of VR-based BF on panic symptoms.

Participants who scored ≥ 10 on Patient Health Questionnaire-9 or ≥ 9 on Panic Disorder Severity Scale (PDSS) were grouped as participants with depressive or anxiety symptoms (DAS), and were randomly distributed into two intervention groups: the VR-based BF (DAS/VR group) and the conventional BF with a therapist (DAS/BF group). Those who did not meet the criteria were classified as the healthy control group and received the VR-based BF intervention (VR group). The interventions were administered three times over the course of one month. A total of 116 participants were analyzed.

The DAS/VR group and DAS/BF group showed a significant decrease in PDSS, indicating that both VR-based BF and conventional BF significantly decreased panic symptoms in individuals with DAS. The mean reduction of PDSS total score for the DAS/VR group was 1.51 (standard deviation [SD] = 2.28), and for the DAS/BF group it was 1.11 (SD = 2.31). However, agoraphobic fear and avoidance (p = 0.003), panic and limited symptoms attacks (p = 0.002), and interference of panic on social activities (p = 0.008) showed a significant decrease only in the VR-based BF but not in conventional BF between baseline and 4 weeks of treatment. Both therapies showed improvement in severity of panic attacks and interference of panic on work.

VR-based BF was effective in decreasing panic symptoms. Notably, it showed a significant reduction in agoraphobic fear and avoidance, whereas conventional BF did not.