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 (<i>N</i> = 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 (<i>F</i> = 17.85, <i>p</i> < .001, <i>η²</i>_<i>m</i> = .43), without main (<i>F</i> = 1.58, <i>p</i> = .21, <i>η²</i>_<i>m</i> = .05) or interaction effects (<i>F</i> = .719, <i>p</i> = .54, <i>η²</i>_<i>m</i> = .03). Yet, the experimental group showed a significantly higher remission rate at follow-up (<i>χ²</i> (1) = 4.57, <i>p</i> = .033, <i>w</i> = .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.