Kim Byung-Hoon, Kim Jae-Jin, Oh Jooyoung, Kim Seung-Hyun, Han Changsu, Jeong Hyun-Ghang, Lee Moon-Soo, Kim Junhyung
Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea.
Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Front Psychiatry. 2023 Jan 24;14:1084255. doi: 10.3389/fpsyt.2023.1084255. eCollection 2023.
Recurrences and diagnostic instability of panic disorder (PD) are common and have a negative effect on its long-term course. Developing a novel assessment tool for anxiety that can be used in a multimodal approach may improve these problems in panic disorder patients. This study assessed the feasibility of virtual reality-based assessment in panic disorder (VRA-PD).
Twenty-five patients with PD (ANX group) and 28 healthy adults (CON group) participated in the study. VRA-PD consisted of four modules based on the key components of cognitive behavior therapy for an anxiety disorder: "Baseline evaluation module" (M0), "Daily environment exposure module" (M1), "Relaxation module" (M2), and "Interoceptive exposure module" (M3). Multiple evaluations, including self-rating anxiety scores (AS) and physiological responses [heart rate variability (HRV) index], were performed in three steps at M1, M2, and M3, and once at M0. Comparisons between patients with PD and healthy controls, factor analysis of variables in VRA-PD, changes in responses within modules, and correlation analysis between variables in VRA-PD and anxiety symptoms assessed by psychological scales were performed.
All participants completed the VRA-PD without discontinuation. The ANX group reported significantly higher AS for all steps and a smaller HRV index in M1 (steps 1 and 2) and M2 (step 1). Repeated-measures analysis of covariance (ANCOVA) revealed significant interaction effects for AS in M1 ( = 4.09, = 0.02) and M2 ( = 4.20, = 0.02), and HRV index in M2 ( = 16.22, < 0.001) and M3 (F = 21.22, p = 0.02). The HRV index only indicated a good model fit for the three-factor model, reflecting the construct of the VRA-PD. Both AS and HRV indexes were significantly correlated with anxiety and depression symptoms.
The current study provides preliminary evidence that the VRA-PD could be a valid anxiety behavior assessment tool.
惊恐障碍（PD）的复发和诊断不稳定性很常见，且对其长期病程有负面影响。开发一种可用于多模式方法的新型焦虑评估工具可能会改善惊恐障碍患者的这些问题。本研究评估了基于虚拟现实的惊恐障碍评估（VRA-PD）的可行性。
25名惊恐障碍患者（焦虑组）和28名健康成年人（对照组）参与了本研究。VRA-PD由基于焦虑障碍认知行为疗法关键成分的四个模块组成：“基线评估模块”（M0）、“日常环境暴露模块”（M1）、“放松模块”（M2）和“内感受性暴露模块”（M3）。在M1、M2和M3分三步进行多次评估，包括自评焦虑评分（AS）和生理反应[心率变异性（HRV）指数]，在M0进行一次评估。对惊恐障碍患者和健康对照进行比较，对VRA-PD中的变量进行因子分析，分析模块内反应的变化，以及VRA-PD中的变量与心理量表评估的焦虑症状之间的相关性分析。
所有参与者均完成了VRA-PD，无中断情况。焦虑组在所有步骤中的AS均显著更高，且在M1（步骤1和2）和M2（步骤1）中的HRV指数更小。重复测量协方差分析（ANCOVA）显示，M1（F = 4.09，p = 0.02）和M2（F = 4.20，p = 0.02）中的AS以及M2（F = 16.22，p < 0.001）和M3（F = 21.22，p = 0.02）中的HRV指数存在显著交互作用。HRV指数仅表明对反映VRA-PD结构的三因素模型拟合良好。AS和HRV指数均与焦虑和抑郁症状显著相关。
当前研究提供了初步证据，表明VRA-PD可能是一种有效的焦虑行为评估工具。
