American Psychiatric Association Annual Meeting

American Psychiatric Association Annual Meeting

May 22, 2017
2 min read

Computer simulation useful to study anxiety in patients with panic disorder, agoraphobia

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SAN DIEGO — Computer simulation is a useful tool to research and treat anxiety in patients with panic disorder and agoraphobia because one has “total control” over the exposure, a researcher said here at the American Psychiatric Association Annual Meeting.

Rafael C. Freire, MD, PhD, of the Federal University of Rio de Janeiro, discussed the state-of-the-art treatment methods and produced further evidence of the benefit of computer simulation.

“Exposure is the gold standard but sometimes the in vivo exposure can be too anxiogenic for the patients ... and it is very hard to control the factors involved in the exposure,” he said. “If you are in the real world, in the street or in a subway or in a bus you cannot control the traffic. You cannot control how many people will be there or how long it takes for the bus or subway train to get to the station. So [there are] a lot of factors that are very hard to control.”

Imagery, Freire said, is another method to treat patients but it is not very anxiogenic and the duration is short.

“We think virtual reality and computer simulations have some advantages over other cognitive methods because you have total control over the virtual environment,” Freire said.

Increasingly higher image quality has improved immersion. Freire has used computer simulation exposure therapy in phobias such as fear of flying, fear of snakes, etc.

Freire presented early results of a study of 30 patients who had panic disorder and were not receiving medication, and 30 healthy patients. They used the Panic and Agoraphobia Scale and EKG and skin conductance electrodes and connected patients to a respiratory circuit.

The test pattern was 40 seconds of neutral stimulus followed by 3 minutes of computer simulation of a short bus ride that included getting on the bus, the bus getting crowded and the bus going through a tunnel, followed by 20 seconds of neutral stimulus.

Patients were tested before and after the computer simulation with the Subjective Units of Distress Scale (SUDS), the Diagnostic Symptom Questionnaire (DSQ) and the Igroup Presence Questionnaire (IPQ).

Patients with panic disorder had a higher baseline anxiety level compared with the healthy patients, Freire said. The computer simulation did produce an increase in anxiety in the patients with panic disorder, but not in the healthy patients.

The researchers asked patients if they had a panic attack. Although many said they did not, about 40% said that they did have panic attacks, Freire said.

Freire is still analyzing the data from heart rate, skin conduction and respiration.

“This kind of test may be very interesting for us to learn more about panic attacks and specifically how to stop panic attacks,” Freire said. “This kind of research can be useful to discover new treatments and new ways to stop panic attacks.”– by Joan-Marie Stiglich, ELS


Freire RC. Panic attacks induced by computer simulation in patients with panic disorder and agoraphobia. Presented at: American Psychiatric Association Annual Meeting; May 20-24, 2017; San Diego.

Disclosure: Freire reports no financial disclosures.