title: Virtual reality exposure therapy does not provide any additional value in agoraphobic patients: a randomized controlled trial.
abstract: BACKGROUND
  A number of studies have demonstrated the efficacy of virtual reality exposure therapy (VRET) in specific phobias, but research in seriously impaired patients with agoraphobia is lacking. In this randomized controlled trial with patients with agoraphobia and panic disorder, VRET and exposure in vivo were compared in terms of outcome and processes involved.
  
  
  METHODS
  Patients with panic disorder with agoraphobia (n = 55) were randomly assigned to receive 4 sessions of cognitive behavioral therapy (CBT) followed by either 6 sessions of VRET or 6 sessions of exposure in vivo or to a waiting list control condition.
  
  
  RESULTS
  Analyses showed that both active treatment packages were significantly more effective than no treatment and that no differences between VRET and exposure in vivo were found in three out of four outcome measures. On the panic disorder severity scale, however, CBT plus exposure in vivo was more effective than CBT plus VRET. The results show clear synchrony of temporal processes involved in VRET and exposure in vivo on weekly avoidance measures and cognitive measures. Further, it was shown that initial changes in agoraphobic cognitions during the CBT phase predicted later changes in agoraphobic avoidance behavior.
  
  
  CONCLUSIONS
  These data support the notion that therapeutic processes involved might be the same in VRET and exposure in vivo. However, given the slight superiority of exposure in vivo above VRET, the costs involved in the implementation of VRET and the lack of long-term follow-up, VRET cannot yet be recommended for patients with agoraphobia.
authors.affiliation: Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands. K.Meyerbroker@uva.nl
authors.forename: K
authors.initials: K
authors.lastname: Meyerbroeker
authors.forename: N
authors.initials: N
authors.lastname: Morina
authors.forename: G A
authors.initials: GA
authors.lastname: Kerkhof
authors.forename: P M G
authors.initials: PM
authors.lastname: Emmelkamp
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000379:Agoraphobia / Q000523:psychology / Q000628:therapy*; D000704:Analysis of Variance; D001007:Anxiety / Q000523:psychology; D001362:Avoidance Learning; D015928:Cognitive Behavioral Therapy; D006801:Humans; D007171:Implosive Therapy / Q000379:methods; D057194:Intention to Treat Analysis; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D016584:Panic Disorder / Q000523:psychology / Q000628:therapy*; D057566:Self Report; D012720:Severity of Illness Index; D063367:Virtual Reality Exposure Therapy / Q000379:methods*; D014850:Waiting Lists; D055815:Young Adult