Previously submitted to: JMIR Mental Health (no longer under consideration since Nov 03, 2025)
Date Submitted: Nov 2, 2025
Open Peer Review Period: Nov 3, 2025 - Nov 3, 2025
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Comparisons of Virtual Reality-based vs. Conventional Biofeedback for Panic Symptoms: A Randomized Controlled Study
ABSTRACT
Virtual reality (VR)-based biofeedback (BF) is being studied as a new type of treatment in the field of psychiatry. We explored the potential of VR-based BF on panic symptoms. Participants who scored ≥10 on Patient Health Questionnaire-9 or ≥9 on Panic Disorder Severity Scale (PDSS) were grouped as participants with depressive or anxiety symptoms (DAS), and were randomly distributed into two intervention groups: the VR-based BF (DAS/VR group) and the conventional BF with a therapist (DAS/BF group). Those who did not meet the criteria were classified as the healthy control group and received the VR-based BF intervention (HC/VR group). The interventions were administered three times over the course of one month. A total of 116 participants were analyzed. The DAS/VR group and DAS/BF group showed a significant decrease in PDSS, indicating that both VR-based BF and conventional BF significantly decreased panic symptoms in individuals with DAS. The mean reduction of PDSS total score for the DAS/VR group was 1.51 (SD=2.28), and for the DAS/BF group it was 1.11 (SD=2.31). However, ‘Agoraphobic fear and avoidance’(p=0.003), ‘panic and limited symptoms attacks’(p=0.002), and ‘interference of panic on social activities’(p=0.008) showed a significant decrease only in the VR-based BF but not in conventional BF between baseline and 4 weeks of treatment. Both therapies showed improvement in ‘severity of panic attacks’ and ‘interference of panic on work’. In conclusion, VR-based BF was effective in decreasing panic symptoms, and was more effective than conventional BF with a therapist in decreasing agoraphobic fear and avoidance.
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