title: Anxiogenic properties of a computer simulation for panic disorder with agoraphobia.
abstract: BACKGROUND
  There are several useful methods to induce anxiety in patients with panic disorder with agoraphobia (PDA). Our aim was to ascertain if a computer simulation (CS) could induce anxiety and physiologic alterations in PDA patients.
  
  
  METHODS
  10 healthy controls (HC) and 10 patients who fulfilled DSM-IV criteria for PDA were recruited for this study. The anxiety level was measured with the Subjective Units of Distress Scale (SUDS) and the Diagnostic Symptom Questionnaire (DSQ) was used to ascertain panic attack (PA) symptoms. The heart rate, skin conductance and respiration were monitored during exposure to the CS. The CS was a 3D computer animation of a short bus trip, from a first person perspective.
  
  
  RESULTS
  In PDA patients CS exposure increased anxiety levels, they also had higher scores in the DSQ and two of them had PA. Compared to the HC, the PDA patients had higher skin conductance level, electrodermal response magnitude, respiratory rate, tidal volume, and respiratory rate irregularities. The heart rate means were higher for PDA patients who had PA, followed by HC and PDA patients who did not have PA. There were no significant differences between the two groups regarding the sense of presence.
  
  
  CONCLUSIONS
  The main limitations were the small sample size, and some PDA patients under medications.
  
  
  CONCLUSIONS
  This study indicated that CS exposure may induce anxiety, electrodermal and respiratory alterations in patients with PDA. CS exposure may be a useful tool in the research and treatment of PD patients.
authors.affiliation: Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. rafaelcrfreire@gmail.com
authors.forename: Rafael C
authors.initials: RC
authors.lastname: Freire
authors.forename: Marcele R
authors.initials: MR
authors.lastname: De Carvalho
authors.forename: Mateus
authors.initials: M
authors.lastname: Joffily
authors.forename: Walter A
authors.initials: WA
authors.lastname: Zin
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Nardi
mesh_terms: D000328:Adult; D000379:Agoraphobia / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology*; D001143:Arousal / Q000502:physiology; D003198:Computer Simulation; D003936:Diagnosis, Computer-Assisted; D005239:Fear / Q000502:physiology; D005260:Female; D005712:Galvanic Skin Response / Q000502:physiology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology*; D010555:Personality Inventory / Q000706:statistics & numerical data; D011594:Psychometrics; D012016:Reference Values; D056152:Respiratory Rate / Q000502:physiology; D012931:Social Environment; D013990:Tidal Volume / Q000502:physiology; D014584:User-Computer Interface