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 anxietyinducing 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.