Cognitive-behavioral treatment and antidepressants combined with virtual reality exposure for patients with chronic agoraphobia

  1. Peñate Castro, Wenceslao
  2. Roca Sánchez, María José
  3. Pitti González, Carmen Teresa
  4. Bethencourt Pérez, Juan Manuel
  5. Fuente Portero, Juan Antonio de la
  6. Gracia Marco, Ramón
International journal of clinical and health psychology

ISSN: 1697-2600

Ano de publicación: 2014

Volume: 14

Número: 1

Páxinas: 9-17

Tipo: Artigo

DOI: 10.1016/S1697-2600(14)70032-8 DIALNET GOOGLE SCHOLAR

Outras publicacións en: International journal of clinical and health psychology


In this study we compared the efficacy of virtual reality exposure combined with cognitive-behavioral therapy (VRET) to that of traditional cognitive-behavioral therapy (CBT) alone in reducing phobic symptoms in a sample of patients with long-term agoraphobia. The study was a between-subject design with three experimental conditions (VRET group, N = 30; CBT group, N = 30; and medication only group, N = 20) and repeated measures (pre-treatment, post-treatment, and six-month follow-up). All patients were receiving antidepressant medication. Results showed that all therapies were statistically effective both at post-treatment and six-month follow-up. The VRET group showed clinical improvement in most variables measured at follow-up. The CBT group showed the highest dropout rates. These results are discussed pointing out that VRET probably serves as an intermediate procedure for an efficient exposure to phobic stimuli. Besides describing the advantages of VRET for the treatment of agoraphobia symptoms in cost-benefit terms, the study also considered issues related to higher treatment adherence and motivation.

Información de financiamento

This study was supported by grant PSI2009-09836 (Spanish Ministry of Science and Innovation), and grant SolSubC200801000084 (Canary Islands Agency for Research, Innovation and the Information Society).


Referencias bibliográficas

  • Abramowitz, J.S., Deacon, B.J., Whiteside, S.P.(2011).Exposure therapy for anxiety: Principles and practice.New York:Guilford Press.
  • Alsina-Jurnet, I., Gutiérrez-Maldonado, J., Rangel-Gómez, M.V.(2011).The role of presence in the level of anxiety experienced in clinical virtual environments.Computers in Human Behavior,27, 504-512.
  • American Psychiatric Association, APA.(2000).Diagnostic and statistical manual of mental disorders (4th.ed., text rev.).Washington:Author.
  • Baker, S.L., Patterson, M.D., Barlow, D.H.(2002).Panic disorder and agoraphobia.In M.M.Anthony & D.H.Barlow (Eds.), Handbook of assessment and treatment planning for psychological disorders (pp.67-112).New York: Guilford Press.
  • Balooch, S.B., Neumann, D.L.(2011).Effects of multiple contexts and context similarity on the renewal of extinguished conditioned conditioned behaviour in an ABA design with humans.Learning and Motivation, 42, 53-63.
  • Beck, A.T., Epstein, N., Brown, G., Steer, R.A.(1988).An inventory for measuring clinical anxiety: Psychometric properties.Journal of Consulting and Clinical Psychology, 56, 893-897.
  • Botella, C., García-Palacios, A., Villa, H., Baños, R.M., Quero, S.,Alcañiz, M., Riva, G.(2007).Virtual reality exposure in the treatment of panic disorder and agoraphobia: A controlled study.Clinical Psychology & Psychotherapy, 14, 164-175.
  • Chambless, D.L., Caputo, G.C., Bright, P., Gallagher, R.(1984).Assessment of fear in agoraphobics: The body sensations questionnaire and the agoraphobic cognitions questionnaire.Journal of Consulting and Clinical Psychology, 52, 1090-1097.
  • Choi, Y.H., Vincelli, F., Riva, G., Wiederhold, B.K., Lee, J.H., Park, K.H.(2005).Effects of group experiential cognitive therapy for the treatment of panic disorder with agoraphobia.CyberPsychology & Behavior, 8, 387-393.
  • Culver, N.C., Stoyanova, M., Craske, M.G.(2012).Emotional variability and sustained arousal during exposure.Journal of Behavior Therapy and Experimental Psychiatry, 43, 787-793.
  • de Carvalho, M.R., Freire, R.C., Nardi, A.E.(2010).Virtual reality as a mechanism for exposure therapy.The World Journal of Biological Psychiatry, 11, 220-230.
  • Echeburúa, E., Corral, P., García, E., Páez, D., Borda, M.(1992).Un nuevo Inventario de Agorafobia (IA).Análisis y Modificación de Conducta, 18, 101-123.
  • ESEMed (2004).Disability and quality of life impact of mental disorders in Europe: Results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.Acta Psychiatrica Scandinavica, 109, 38-46.
  • Farach, F.J., Pruitt, L.D., Jun, J.J., Jerud, A.B., Zoellner, L.A., Roy-Byrne, P.P.(2012).Pharmacological treatment of anxiety disorders: Current treatments and future directions.Journal of Anxiety Disorders, 26, 833-843.
  • Foa, E.B., Huppert, J.D., Cahill, S.P.(2006).Emotion processing theory: An update.In B.O.Rothbaum (Ed.), Pathological anxiety:Emotional processing in etiology and treatment (pp.3-24).New York: Guilford Press.
  • Gonzalez-Lorenzo, M., Peñate, W., Pitti, C.T., Bethencourt, J., de la Fuente, J., Gracia, R.(2011).Efficacy of virtual reality exposure therapy combined with two pharmacotherapies in the treatment of agoraphobia.International Journal of Clinical and Health Psychology, 11, 189-203.
  • Hartley, J.(2012).New ways of making academic articles easier to read.International Journal of Clinical Health Psychology, 12, 143-160.
  • Heimberg, R.G., Horner, K.J., Juster, H.R., Safren, S.A., Brown,E.J., Schneier, F.R., Liebowitz, M.R.(1999).Psychometric properties of the Liebowitz Social Anxiety Scale.Psychological Medicine, 29, 199-212.
  • Kämpfe, C.K., Gloster, A.T., Wittchen, H.U, Helbig-Lang, S., Lang,T., Gerlach, A.L., Richter, J., Alpers, G.W., Fehm, L., Kircher,T., Hamm, A.O., Ströhle, A., Deckert, J.(2012).Experiential avoidance and anxiety sensitivity in patients with panic disorder and agoraphobia: Do both constructs measure the same? International Journal of Clinical Health Psychology, 12, 5-22.
  • Kessler, R.C., Ustün, T.B.(2004).The World Mental Health (WMH)Survey Initiative Version of the World Health Organization (WHO)Composite International Diagnostic Interview (CIDI).International Journal of Methods in Psychiatric Research, 13, 93-121.
  • Krijn, M., Emmelkamp, P.M.G., Olafsson, R.P., Biemond, R.(2004).Virtual reality exposure therapy of anxiety disorders:A review.Clinical Psycholology Review, 24, 259-281.
  • Liebowitz, M.R.(1987).Social phobia.Modern Problems in Pharmacopsychiatry,22, 141-173.
  • Malbos, E., Rapee, R.M., Kavakli, M.(2013).A controlled study of agoraphobia and the independent effect of virtual reality exposure therapy.Australian and New Zealand Journal of Psychiatry,47, 160-168.
  • Meyerbröker, K., Emmelkamp, P.M.G.(2010).Virtual reality exposure therapy in anxiety disorders: A systematic review of process-and-outcome studies.Depression & Anxiety, 27, 933-944.
  • Meyerbroeker, K., Morina, N., Kerkhof, G.A., Emmelkamp, P.M.G.(2013).Virtual reality exposure therapy does not provide any additional value in agoraphobic patients: A randomized controlled trial.Psychotherapy and Psychosomatics, 82, 170-176.
  • Mochcovitch, M.D., Nardi, A.E.(2010).Selective serotonin-reuptake inhibitors in the treatment of panic disorder: A systematic review of placebo-controlled studies.Expert Review of Neurotherapeuthics, 10, 1285-1293.
  • Montero, I., León, O.G.(2007).A guide for naming research studies in psychology.International Journal of Clinical and Health Psychology, 7, 847-862.
  • Neudeck, P., Wittchen, H.U.(Eds.) (2012).Exposure therapy.Rethinking the model-refining the method.New York: Springer.
  • Opris, D., Pintea, S., García-Palacios, A., Botella, C., Szamosközi,S., David, D.(2012).Virtual reality exposure therapy in anxiety disorders: A quantitative meta-analysis.Depression & Anxiety,29, 85-93.
  • Peñate, W.(2012).About the effectiveness of telehealth procedures in psychological treatments.International Journal of Clinical and Health Psychology, 12, 475-487.
  • Peñate, W., Pitti, C.T., Bethencourt, J.M., de la Fuente, J., Gracia,R.(2008).The effects of a treatment based on the use of virtual reality exposure and cognitive-behavioral therapy applied to patients with agoraphobia.Preliminary results.International Journal of Clinical Health Psychology, 8, 5-22.
  • Pitti, C.T., Peñate, W., de la Fuente, J., Bethencourt, J., Acosta,L., Villaverde, M., Gracia, R.(2008).Agoraphobia: Combined treatment and virtual reality.Preliminary results.Actas Españolas de Psiquiatría, 36, 94-101.
  • Powers, M.B., Emmelkamp, P.M.G.(2008).Virtual reality exposure therapy for anxiety disorders: A meta-analysis.Journal of Anxiety Disorders, 22, 561-569.
  • Reinecke, A., Rinck, M., Becker, E.S., Hoyer, J.(2013).Cognitivebehavior therapy resolves implicit fear associations in generalized anxiety disorder.Behaviour Research and Therapy, 51, 15-23.
  • Shiban,Y., Pauli, P., Mühlberger, A.(2013).Effect of multiple context exposure on renewal in spider phobia.Behaviour Research and Therapy, 51, 68-74.
  • Wiederhold, B.K., Rizzo, A.S.(2005).Virtual reality and applied psychophysiology.Applied Psychophysiology and Biofeedback,30, 183-185.
  • World Health Organization [WHO] (1992). ICD-10: International Statistical Classification of Diseases and Related Health Problems.Geneve: Author.