Electroencephalogram Changes After Virtual Reality-Based Cognitive Behavioral Therapy for Panic Disorder

Abstract

Background: Cognitive behavioral therapy (CBT) for panic disorder involves training to cope with anxiety and panic attacks effectively. Recently, CBT, when integrated with anxiety-inducing virtual reality (VR) scenarios, has been utilized to treat panic disorder. This study aimed to investigate the neurophysiological impacts of VR-enhanced CBT in the treatment of panic disorder. Materials: Nineteen patients (6 men and 13 women; average age: 36.0 ± 11.7 years) diagnosed with panic disorder participated in four sessions of VR-based CBT. The VR program included educational elements focusing on abdominal breathing and muscle relaxation and training components that utilized relaxation techniques during exposure to a VR environment. Psychometric assessments and electroencephalogram (EEG) readings were collected before and after the CBT sessions. The EEG studies were performed under two conditions: a resting state and while engaging in a visual working memory task. Results: The Panic Disorder Severity Scale for panic symptoms improved following VR-based CBT. Although error rates in the Stroop test did not change before and after CBT, reaction times improved. Additionally, several EEG indicators exhibited differences pre- and post-CBT, with increased left frontal beta and parietal theta power observed during a visual working memory task. Conclusion: This study indicated that VR-based CBT may alleviate panic symptoms and enhance cognitive functions, particularly executive control. Additionally, EEG results suggested that VR-based CBT could strengthen brain activity associated with working memory performance.