Interoceptive exposure and habituation for depersonalization and derealization symptoms in the treatment of panic disorder

There has been significant support for the use of interoceptive exposure techniques in the cognitive behavioral treatment (CBT) of panic disorder. However, to date, there has been very little research into effective techniques to specifically address the panic symptoms of depersonalization (DP) and derealization (DR) within such CBT protocols. This is problematic in light of research indicating that the presence of DP/DR as part of a panic disorder symptom profile is associated with more severe general panic symptoms, higher frequency of attacks, greater impairment in functioning, and increased chance of developing agoraphobia. There are indications that the presence of DP/DR in panic disorder represents a poor prognosis for treatment and may possibly represent a more severe form of the disorder. This is the first randomized controlled study to compare the traditional DP/DR induction technique of hyperventilation to the novel technique of exposure to strobe light while wearing 3D glasses. Students prone to panic were compared to an anxious control group of students prone to spider phobia (N = 37). Participants were administered a 3-week, once-a-week, 20-minute exposure protocol in each condition and asked to rate symptoms of DP/DR at various time-points in order to assess if symptom induction and habituation had occurred. Results indicate that habituation to these sensations did occur in both conditions and across all groups and that the efficacy of the strobe light plus 3D glasses exposure method does not differ from that of the traditional technique of hyperventilation. This is important as there is some evidence to suggest that CBT clinicians are hesitant to use hyperventilation in practice so providing alternative effective techniques is essential. Seeing that the presence of DP/DR symptoms may represent a more severe form of panic disorder, the development of enhanced treatment options could also have larger public health implications. This study provides additional support for the use of strobe light plus 3D glasses in targeting DP/DR symptoms in exposure based treatments for panic disorder and provides support for its use by CBT clinicians as an affordable, targeted, effective tool in the treatment of DP/DR in panic disorder