Anxiogenic properties of a computer simulation for panic disorder with agoraphobia.

BACKGROUND There are several useful methods to induce anxiety in patients with panic disorder with agoraphobia (PDA). Our aim was to ascertain if a computer simulation (CS) could induce anxiety and physiologic alterations in PDA patients. METHODS 10 healthy controls (HC) and 10 patients who fulfilled DSM-IV criteria for PDA were recruited for this study. The anxiety level was measured with the Subjective Units of Distress Scale (SUDS) and the Diagnostic Symptom Questionnaire (DSQ) was used to ascertain panic attack (PA) symptoms. The heart rate, skin conductance and respiration were monitored during exposure to the CS. The CS was a 3D computer animation of a short bus trip, from a first person perspective. RESULTS In PDA patients CS exposure increased anxiety levels, they also had higher scores in the DSQ and two of them had PA. Compared to the HC, the PDA patients had higher skin conductance level, electrodermal response magnitude, respiratory rate, tidal volume, and respiratory rate irregularities. The heart rate means were higher for PDA patients who had PA, followed by HC and PDA patients who did not have PA. There were no significant differences between the two groups regarding the sense of presence. LIMITATIONS The main limitations were the small sample size, and some PDA patients under medications. CONCLUSIONS This study indicated that CS exposure may induce anxiety, electrodermal and respiratory alterations in patients with PDA. CS exposure may be a useful tool in the research and treatment of PD patients.

[1]  V. Niccolai,et al.  Objective and Subjective Measures in Recovery from a 35% Carbon Dioxide Challenge , 2008, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[2]  J. Kinney,et al.  Ventilatory physiology of patients with panic disorder. , 1988, Archives of general psychiatry.

[3]  J. Gorman,et al.  Respiratory psychophysiology of panic disorder: three respiratory challenges in 98 subjects. , 1997, The American journal of psychiatry.

[4]  J. Gorman,et al.  Respiratory physiology and pathological anxiety. , 1987, General hospital psychiatry.

[5]  D. Caldirola,et al.  Panic disorder: from respiration to the homeostatic brain , 2004, Acta Neuropsychiatrica.

[6]  E. Gracely,et al.  The Mobility Inventory for Agoraphobia. , 1985, Behaviour research and therapy.

[7]  R. Baños,et al.  Virtual reality exposure in the treatment of panic disorder and agoraphobia: A controlled study , 2007 .

[8]  L. Ost,et al.  Cognitive behavior therapy vs exposure in vivo in the treatment of panic disorder with agoraphobia (corrected from agrophobia). , 2004, Behaviour research and therapy.

[9]  W. Roth,et al.  Autonomic instability during relaxation in panic disorder , 1998, Psychiatry Research.

[10]  M. Craske,et al.  Autonomic reactivity of panic patients during a CO2 inhalation procedure , 2000, Depression and anxiety.

[11]  J. Gorman,et al.  Effect of Antipanic Treatment on Response to Carbon Dioxide , 1997, Biological Psychiatry.

[12]  J. Gorman,et al.  Symptoms Essential to the Experience of Sodium Lactate-Induced Panic , 1996, Neuropsychopharmacology.

[13]  T. Hergueta,et al.  The mini international neuropsychiatric interview , 1998, European Psychiatry.

[14]  D. Chambless,et al.  Assessment of fear of fear in agoraphobics: the body sensations questionnaire and the agoraphobic cognitions questionnaire. , 1984, Journal of consulting and clinical psychology.

[15]  Lars-Göran Öst,et al.  Cognitive behavior therapy vs exposure in vivo in the treatment of panic disorder with agrophobia , 2004 .

[16]  Antonio Egidio Nardi,et al.  Virtual reality as a mechanism for exposure therapy , 2010, The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry.

[17]  Graham Turpin,et al.  HANDBOOK OF CLINICAL PSYCHOPHYSIOLOGY , 1990, Clinical Psychology Forum.

[18]  R. Freire,et al.  A caffeine challenge test in panic disorder patients, their healthy first‐degree relatives, and healthy controls , 2008, Depression and anxiety.

[19]  D. Sheehan,et al.  The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. , 1998, The Journal of clinical psychiatry.

[20]  Giuseppe Riva,et al.  Effects of Group Experiential Cognitive Therapy for the Treatment of Panic Disorder with Agoraphobia , 2005, Cyberpsychology Behav. Soc. Netw..

[21]  R. Freire,et al.  Psychopathological profile of 35% CO2 challenge test-induced panic attacks: a comparison with spontaneous panic attacks. , 2006, Comprehensive psychiatry.

[22]  C. Papageorgiou,et al.  Caffeine challenge in patients with panic disorder: baseline differences between those who panic and those who do not , 2008, Depression and anxiety.

[23]  R. Freire,et al.  Panic disorder respiratory subtype: A comparison between responses to hyperventilation and CO2 challenge tests , 2008, Psychiatry Research.

[24]  Randolph M Nesse,et al.  Persistent respiratory irregularity in patients with panic disorder , 2001, Biological Psychiatry.

[25]  V. Masdrakis,et al.  Caffeine challenge and breath-holding duration in patients with panic disorder , 2009, Progress in Neuro-Psychopharmacology and Biological Psychiatry.

[26]  J. Gorman,et al.  Lactate provocation of panic attacks. II. Biochemical and physiological findings. , 1985, Archives of general psychiatry.

[27]  Dong Pyo Jang,et al.  Physiological Monitoring as an Objective Tool in Virtual Reality Therapy , 2002, Cyberpsychology Behav. Soc. Netw..

[28]  S. Hollon,et al.  6 – Cognitive Therapy of Depression1 , 1979 .

[29]  Holger Regenbrecht,et al.  The Experience of Presence: Factor Analytic Insights , 2001, Presence: Teleoperators & Virtual Environments.

[30]  K. Dobson,et al.  Cognitive therapy of depression: pretreatment patient predictors of outcome. , 2002, Clinical psychology review.

[31]  Stéphane Bouchard,et al.  Experiential Cognitive Therapy in the Treatment of Panic Disorders with Agoraphobia: A Controlled Study , 2003, Cyberpsychology Behav. Soc. Netw..

[32]  P. Amorim.  Mini International Neuropsychiatric Interview (MINI): validacao de entrevista breve para diagnostico de transtornos mentais , 2000 .

[33]  P Bech,et al.  Mini-compendium of rating scales for states of anxiety depression mania schizophrenia with corresponding DSM-III syndromes. , 1986, Acta psychiatrica Scandinavica. Supplementum.

[34]  D H Barlow,et al.  The influence of an illusion of control on panic attacks induced via inhalation of 5.5% carbon dioxide-enriched air. , 1989, Archives of general psychiatry.

[35]  A. Beck,et al.  An inventory for measuring clinical anxiety: psychometric properties. , 1988, Journal of consulting and clinical psychology.

[36]  R. Goetz,et al.  Physiological and behavioral effects of naloxone and lactate in normal volunteers with relevance to the pathophysiology of panic disorder , 2007, Psychiatry Research.

[37]  M. Craske,et al.  Laboratory psychophysiological assessment and imagery exposure in panic disorder patients , 2000, Depression and anxiety.

[38]  R. Freire,et al.  Caffeine and 35% carbon dioxide challenge tests in panic disorder , 2007, Human psychopharmacology.

[39]  J. Neumann.  Distribution of the Ratio of the Mean Square Successive Difference to the Variance , 1941 .

[40]  M K Shear,et al.  Multicenter collaborative panic disorder severity scale. , 1997, The American journal of psychiatry.

[41]  Concepción Perpiñá,et al.  Clinically Significant Virtual Environments for the Treatment of Panic Disorder and Agoraphobia , 2004, Cyberpsychology Behav. Soc. Netw..

[42]  D. Caldirola,et al.  Antipanic Drug Modulation Of 35% CO2 Hyperreactivity and Short-Term Treatment Outcome , 2002, Journal of clinical psychopharmacology.

[43]  E. Volchan,et al.  Freezing reaction in panic disorder patients associated with anticipatory anxiety , 2009, Depression and anxiety.