Panic and Agoraphobia in a Virtual World KEELY MOORE, M.S., 1 BRENDA K. WIEDERHOLD, Ph.D., M.B.A., BCIA, 1 MARK D. WIEDERHOLD, M.D., Ph.D., 1 and GIUSEPPE RIVA, Ph.D. 2 ABSTRACT Virtual reality (VR) offers a great new perspective on what it can offer an individual. These new approaches can give an individual the immersion and cognitive guidance that they need to help overcome his or her disorder. VR differs from the traditional displays in computer graphics as these various displays are integrated to give the user a sense of presence or im- mersion in the virtual world. To more effectively treat panic and agoraphobic patients using VR, it is necessary to determine the physiological responses of nonphobics when placed in the virtual panic and agoraphobia environments. This study exposed nonphobic participants to virtual panic and agoraphobia worlds with a program entitled “Virtual Medicine.” Indi- viduals without a diagnosis of panic and agoraphobia, as confirmed by intake and self-report questionnaires, were exposed to four different VR environments (elevator, supermarket, town square, and beach). During these VR experiences, physiology was measured by nonin- vasive sensors (peripheral skin temperature, heart rate, heart rate variability, respiration, and skin conductance). These measurements were compared to baseline physiology, which was recorded for five min prior to the VR exposure. These levels of physiological arousal will be useful in comparing against the phobic responses during virtual exposure. It will be useful to explore differences between immersion, physiological responses, and self-report responses in nonphobics versus phobics. 197 CYBERPSYCHOLOGY &BEHAVIOR Volume 5, Number 3, 2002 © Mary Ann Liebert, Inc. INTRODUCTION P ANIC DISORDER is characterized by an in- tense sense of death, doom, or even de- struction. In community samples, lifetime prevalence rates have been reported as high as 3.5%, with prevalence even higher among clini- cal samples. Of those referred to mental health clinics, approximately 10% are diagnosed with panic disorder. In medical settings, prevalence rates are 10–30% for patients presenting to ves- tibular, neurology, or respiratory clinics, and up to 60% for those presenting to cardiology clinics. Many patients will feel dizzy, hyper- ventilate and gasp for air, sweat, and experi- ence chest pain, nausea, and a fear of losing control or impending death. 1,2 Agoraphobia is a condition that can be diagnosed either with or without panic. A criterion for agoraphobia consists of anxiety about being in places from which escape might be difficult or in which help might not be available. The situations are avoided or else endured with marked distress or anxiety about having a panic attack or panic-like symptoms. Virtual reality (VR) offers an advantage to those suffering from panic with agoraphobia, in that exposure to anxiety-provoking situa- tions can first be attempted in the office. This allows the patient to feel immersed and 1 The Virtual Reality Medical Center, San Diego, California. 2 Instituto Auxologico Italiano, Milan, Italy.