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

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.