Does the Exposure Method Used in Cognitive Behavioural Therapy for Panic Disorder with Agoraphobia Affect Treatment Outcome?

Panic disorder (PD) is characterized by the presence of recurrent unexpected panic attacks and persistent worrying about the occurrence of a new panic attack. 30 to 60 % of PD sufferers develop agoraphobia [PD(A)], a condition characterised by avoidance of anxiety-provoking situations, such as public transport, open or enclosed places or leaving the home alone. Cognitive Behavioral Therapy (CBT) is an effective psychological treatment for PD(A). One of its key components is exposure, a method for systematically approaching anxiety-provoking stimuli. However, up to 30% of PD(A) sufferers find traditional in vivo exposure (IVE) procedures too aversive. One way to increase the likelihood of sufferers engaging in exposure assignments is to carry them out in session. In addition, new exposure methods are being explored as alternatives to traditional IVE, such as virtual reality exposure. However, little is known about how treatment outcomes produced by these different exposure methods compare to one another.

Aim: To review relevant literature to find out whether the exposure method used affects treatment outcomes in CBT for PDA.

Method: A systematic search of the following databases was performed: CINAHL, PsychINFO, Cochrane Library, PsychArticles, Scopus, Medline, and Wed of Science. Inclusion and exclusion criteria were applied to the identified papers and the final set of studies was assessed according to methodological criteria.

Results: Eight papers were included in the review. Four papers were experimental studies comparing different modes of exposure, one paper was a retrospective naturalistic study, and three papers compared virtual reality exposure therapy (VRET)-enhanced CBT to traditional CBT. The methodological quality of the studies and the validity of their conclusions was found to be mixed.

Conclusions: The review concluded that different exposure methods tended to produce similar results. However, some indications of IVE being superior to virtual reality exposure (VRE) were found. Some findings also indicated that the combination of therapist-assisted and self-led exposure might be superior to self-led exposure only. However, studies in this area are low in numbers and of mixed quality, therfore, more high-quality research in needed.