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Psychophysiological Reactivity, Interoception and Emotion Regulation in Patients with Agoraphobia During Virtual Reality Anxiety Induction

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Abstract

The symptoms experienced by patients with agoraphobia are often attributed to excessive autonomic arousal, but recent theories postulate blunted rather than enhanced autonomic reactivity. Cognitive models explain this contrast by distorted interoception, possibly linked to dysfunctional emotion regulation under stress. In the current study, physiological measures were compared directly to their subjective perception in patients with agoraphobia (n = 21) and healthy controls (n = 27) in a virtual reality stressor. Blunted reactivity was confirmed for heart rate and parasympathetic influences on heart rate variability, but measures of sympathetic activation did not differ between groups. As expected, patients showed exaggerated perception of their physiological response. Usage of emotion regulation strategies during the stressor did not differ between groups, but patients reported strong difficulties in perception of and coping with emotions in a trait measure. Our findings suggest that distorted perception of physiological and emotional processes is central to agoraphobia.

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Notes

  1. Our study focus is agoraphobia, with special emphasis on the chronicity of anxiety that is not shared with panic disorder alone. Even though DSM-5 introduced agoraphobia as an independent diagnostic category, much relevant research has been conducted using the DSM-IV diagnosis of panic disorder with (or without) agoraphobia. We present such research where it is relevant to our study, using the authors’ original diagnostic terms (i.e. panic disorder).

  2. Because time spent in the scenario and stressor conditions varied between participants, one to three minutes were used for psychophysiological analyses in each condition, depending on individual availability. Analyses did not change substantially when only using each participant’s first minute in these two conditions.

  3. While the ratio of power in the low frequency band to that in the high frequency band was frequently reported as an indicator of cardiac SNS activity, such a connection has been refuted convincingly (Goedhart et al. 2008). Another measure of parasympathetic control of heart rate frequently reported in the literature, the time domain based square root of the mean squared differences of successive NN intervals (RMSSD) yielded results very similar to the HF-HRV we report.

  4. All values were z-standardized, and the ibi values used as HR indicators were inverted so that higher values indicate faster heartbeat in accordance with the self-report measures.

  5. All rs ≤ .25 with ps ≥ .2 for psychophysiological variables, using difference scores from baseline to stressor. All rs ≤ .35 with ps ≥ .08 for self-report variables. No correction for multiple testing applied.

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Acknowledgments

We thank Christian Becker-Asano and Dali Sun for support with the virtual reality environment, Johannes Rath for assistance with preparation of the psychophysiological data, and Laura Plempe for participating in data collection.

Funding

This study was funded in part through a dissertation grant from Heinrich Böll Stiftung to Christoph Breuninger in the form of funds for personal and material expenses. Development of the virtual reality scenario was supported by a grant from FRIAS (Freiburg Institute of Advanced Studies) to Brunna Tuschen-Caffier and Bernhard Nebel (Department of Computer Science, University of Freiburg).

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  1. Julian Schmitz

    Present address: Department of Clinical Psychology in Children and Youth, Leipzig University, Leipzig, Germany

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  1. Department of Clinical Psychology and Psychotherapy, University of Freiburg, Engelbergerstr. 41, 79106, Freiburg, Germany

    Christoph Breuninger, David M. Sláma, Martina Krämer, Julian Schmitz & Brunna Tuschen-Caffier

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Christoph Breuninger, David M. Sláma, Martina Krämer, Julian Schmitz and Brunna Tuschen-Caffier declare that they have no conflict of interest.

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All procedures performed involving human participants were approved by the University of Freiburg ethics committee (153/12) and in accordance with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from all individual participants included in the study.

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Breuninger, C., Sláma, D.M., Krämer, M. et al. Psychophysiological Reactivity, Interoception and Emotion Regulation in Patients with Agoraphobia During Virtual Reality Anxiety Induction. Cogn Ther Res 41, 193–205 (2017). https://doi.org/10.1007/s10608-016-9814-9

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