Efficacy of a blended, mobile-based intervention with integrated virtual reality exposure therapy for panic disorder and agoraphobia: a pilot randomized controlled trial

Panic disorder (PD) and agoraphobia (AG) are prevalent mental health issues. Recent approaches have integrated mobile virtual reality exposure therapy (VRET) into internet- and mobile-based interventions (IMIs) to facilitate exposure therapy, providing a promising supplement to traditional psychotherapy. This preregistered, randomized controlled trial evaluated the efficacy of a guided IMI with integrated VRET for treating PD and AG. Patients (N = 32) were either assigned to the experimental group receiving the IMI with VRET, or the active control group receiving sessions covering stress education and relaxation. The primary outcome, self-reported symptom severity via panic and agoraphobia scale, was assessed at four points: baseline, interim, post-intervention, and follow-up. As the secondary outcome, clinician-rated remission via MINI-Dips was assessed at follow-up. A mixed-effects ANOVA revealed a significant symptom reduction over time (F = 17.85, p < .001, η2m = .43), without main (F = 1.58, p = .21, η2m = .05) or interaction effects (F = .719, p = .54, η2m = .03). Yet, the experimental group showed a significantly higher remission rate at follow-up (χ2 (1) = 4.57, p = .033, w = .378). Both groups experienced similar self-reported symptom alleviation at post-treatment and follow-up. Elevated clinician-rated remission rate in the experimental group points towards the supplementary merit of VRET in this treatment. Differences in the clinician- and self-reported outcomes underscore the importance of multilayered research approaches.