Virtual Reality-Based Treatment Approaches in the Field of Substance Use Disorders

Virtual reality mindfulness training for veterans in residential substance use treatment: Pilot study of feasibility and acceptability

BACKGROUND

Mindfulness training is effective in recovery from substance use disorders; however, adoption can be difficult due to environmental and personal distractions. Virtual reality (VR) may help overcome these challenges by providing an immersive environment for practicing mindfulness, but there is currently limited knowledge regarding patient and provider perceptions of VR-based tools.

OBJECTIVE

The present study investigated the feasibility and acceptability of VR mindfulness training for veterans in residential substance use treatment as well as potential benefits of VR mindfulness interventions in this population. We conducted a pilot feasibility/acceptability study as a first step toward conducting a larger randomized controlled trial (RCT).

METHODS

The study recruited participants (N = 32) from a 30-day residential substance use program and collected both qualitative and quantitative feedback on the VR mindfulness intervention using a mixed-methods approach. Patients (n = 20) and providers (n = 12) rated the acceptability, usability, and satisfaction of the intervention. Using a within-subjects design, patients provided pre-post emotion ratings and reported on state mindfulness and VR presence after completing a single-session self-guided VR mindfulness intervention. Patients provided qualitative interview data on their overall impressions, while providers gave the same information via survey.

RESULTS

Both patients and providers reported high satisfaction and confidence in the intervention. Moreover, within subjects t-tests showed that patients experienced significant reductions in negative affect and significant increases in positive affect from pre-post, along with high levels of state mindfulness and presence. Results of thematic analysis revealed that the intervention facilitated focused attention on the present moment, induced a state of calm and relaxation, and reduced negative thoughts and emotions. Participants requested improvements such as better integration of audiovisual elements, a more personalized and longer intervention, and more comfortable fitting headset. Finally, the intervention presented with several advantages compared to other mindfulness experiences including reduced distractions and a sense of safety and privacy.

CONCLUSIONS

Self-guided VR mindfulness intervention is feasible and acceptable to patients and providers. VR mindfulness training provides an immersive experience that uplifts mood and reduces distractions. VR may provide a scaffolding tool to set the stage for deepening mindfulness skills. Results of the present study could inform further development and tailoring for future interventions.

Virtual Reality Could Help Assess Sexual Aversion Disorder

Virtual reality (VR) may improve our understanding of sexual dysfunctions' manifestations, although research in this area remains limited. This study assessed the potential use of a VR Behavior Avoidance Test (VR-BAT) as a tool for examining the clinical features of Sexual Aversion Disorder (SAD): the experience of fear, disgust, and avoidance when facing sexual cues/contexts. A sample of 55 adults (≥ 18y) with (n = 27) and without SAD (n = 28) completed a self-report measure of sexual avoidance. Their anxiety, disgust, electrodermal activity, heart rate, and visual and behavioral avoidance were then examined during two VR-BATs involving sexual or non-sexual stimuli. Mixed repeated measures ANOVAs, t-tests, and correlational analyses were performed. Results showed that individuals in the SAD group reported greater anxiety and disgust compared to their non-SAD counterparts during the sexual stimuli condition. Sexual avoidance scores were largely positively related to anxiety and disgust during the VR sexual condition, and moderately negatively related to the time spent touching the virtual character's genitals. This study is important given the prevalence of sexual difficulties, such as SAD, and the new research avenues offered by emerging technologies, like VR.

An explorative single-arm clinical study to assess craving in patients with alcohol use disorder using Virtual Reality exposure (CRAVE)-study protocol

BACKGROUND

Alcohol use disorder (AUD) belongs to the most burdensome clinical disorders worldwide. Current treatment approaches yield unsatisfactory long-term effects with relapse rates up to 85%. Craving for alcohol is a major predictor for relapse and can be intentionally induced via cue exposure in real life as well as in Virtual Reality (VR). The induction and habituation of craving via conditioned cues as well as extinction learning is used in Cue Exposure Therapy (CET), a long-known but rarely used strategy in Cognitive Behavioral Therapy (CBT) of AUD. VR scenarios with alcohol related cues offer several advantages over real life scenarios and are within the focus of current efforts to develop new treatment options. As a first step, we aim to analyze if the VR scenarios elicit a transient change in craving levels and if this is measurable via subjective and psychophysiological parameters.

METHODS

A single-arm clinical study will be conducted including n = 60 patients with AUD. Data on severity of AUD and craving, comorbidities, demographics, side effects and the feeling of presence in VR will be assessed. Patients will use a head-mounted display (HMD) to immerse themselves into three different scenarios (neutral vs. two target situations: a living room and a bar) while heart rate, heart rate variability, pupillometry and electrodermal activity will be measured continuously. Subjective craving levels will be assessed before, during and after the VR session.

DISCUSSION

Results of this study will yield insight into the induction of alcohol craving in VR cue exposure paradigms and its measurement via subjective and psychophysiological parameters. This might be an important step in the development of innovative therapeutic approaches in the treatment of patients with AUD.

TRIAL REGISTRATION

This study was approved by the Charité-Universitätsmedizin Berlin Institutional Review Board (EA1/190/22, 23.05.2023). It was registered on ClinicalTrials.gov (NCT05861843).

Immersive virtual plus-maze to examine behavior and psychophysiological-related variables in young people with problematic alcohol and cannabis consumption

Stressful events appear to be risky situations that can precipitate the consumption of drugs. One way to recreate stressful contexts, in an ecological and controlled method, is through immersive virtual reality (VR). In our study, we designed the scenario of an elevated plus-maze (EPM) using VR, which is widely used in animal models to assess unconditioned anxiety. This task allowed us to analyze the behavioral, psychophysiological (heart rate and electrodermal activity), and hormonal response (salivary cortisol and Alpha-amylase) to this stressful situation in different moments (before VR task (anticipation), at the end of the task and 10 minutes later) in young people with problematic alcohol use (AU, n = 27), alcohol combined with cannabis consumption (AU + C, n = 10), as well as in a control group (CO, n = 33). Behavioral analysis revealed that the AU group displayed fewer entries into open arms than the CO group, whereas both experimental groups spent less time at the end of the open arms, as well as lower time by look down index compared to the CO group. Moreover, our VR EPM induced different psychophysiological responses in the different moments measured. In general, electrodermal activity seemed to be a good biomarker of recovery from a stressful situation, as once the exposure to the stressful situation ended, the AU + C group took longer to recover compared to the CO group. Regarding hormonal analyses, we observed a similar response pattern in all groups suggesting that our VR task was able to activate both stress systems. The alpha-amylase to cortisol ratio, proposed as a biomarker of stress systems dysregulation, was higher in the group of young participants with alcohol abuse. Interestingly, our VR EPM was able to induce a slight alcohol craving in both experimental groups. In conclusion, our results suggest certain subtle behavioral and physiological differences that could be used to detect young individuals at risk of future severe addictions or other stress-related comorbidities. Moreover, it could help us to develop prevention strategies focused on emotional, cognitive, and psychophysiological aspects.

Digital interventions for substance use disorders in young people: rapid review

BACKGROUND

Young people are disproportionately more likely than other age groups to use substances. The rise in substance use and related harms, including overdose, during the Covid-19 pandemic has created a critical need for more innovative and accessible substance use interventions. Digital interventions have shown effectiveness and can provide more engaging, less stigmatizing, and accessible interventions that meet the needs of young people. This review provides an overview of recent literature on the nature of recently published digital interventions for young people in terms of technologies used, substances targeted, intended outcomes and theoretical or therapeutic models employed.

METHODS

Rapid review methodology was used to identify and assess the literature on digital interventions for young people. An initial keyword search was conducted using MEDLINE the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment Database (HTA) and PROSPERO for the years 2015-2020, and later updated to December 2021. Following a title/abstract and full-text screening of articles, and consensus decision on study inclusion, the data extraction process proceeded using an extraction grid developed for the study. Data synthesis relied on an adapted conceptual framework by Stockings, et al. that involved a three-level treatment spectrum for youth substance use (prevention, early intervention, and treatment) for any type of substance.

RESULTS

In total, the review identified 43 articles describing 39 different digital interventions. Most were early interventions (n = 28), followed by prevention interventions (n = 6) and treatment interventions (n = 5). The identified digital technologies included web-based (n = 14), game-based (n = 10), mobile-based (n = 7), and computer-based (n = 5) technologies, and virtual reality (n = 3). Most interventions targeted alcohol use (n = 20) followed by tobacco/nicotine (n = 5), cannabis (n = 2), opioids (n = 2), ketamine (1) and multiple, or any substances (n = 9). Most interventions used a personalized or normative feedback approach and aimed to effect behaviour change as the intended outcome. Interestingly, a harm reduction approach guided only one of the 39 interventions.

CONCLUSIONS

While web-based interventions represented the most common type of technology, more recently developed immersive and interactive technologies such as virtual reality and game-based interventions call for further exploration. Digital interventions focused mainly on alcohol use, reflecting less concern for tobacco, cannabis, co-occurring substance use, and illicit drug use. Specifically, the recent exacerbation in the opioid crisis throughout North American underlines the urgent need for more prevention-oriented digital interventions for opioid use. The uptake of digital interventions among youth also depends on the incorporation of harm reduction approaches.

[The application of virtual reality in the treatment of mental disorders]

BACKGROUND

Virtual reality (VR) enables immersion in an interactive digital world with realistic experiences, that can be applied for controlled and personalized interventions. This review summarizes the current research on VR in the treatment of mental disorders.

METHODS

Selective literature search in PubMed and Google Scholar.

RESULTS

An increasing number of publications report the therapeutic application of VR for the treatment of mental disorders. Most VR applications are based on established therapy approaches, such as exposure therapy. According to meta-analytic data, virtual exposure therapy (VRET) for specific phobia and agoraphobia with panic disorder is as effective as traditional in vivo exposure therapy. VRET for the treatment of social phobia is significantly more effective than waitlist and placebo control groups with, however, currently inconsistent metanalytic results when compared to in vivo exposure therapy. VRET for the treatment of posttraumatic stress disorder (PTSD) is similar in effectiveness compared to active psychotherapy. For psychosis, positive results have been reported for the VR-based treatment of auditory verbal hallucinations. For patients with a substance use disorder, VR can induce craving, with still unverified diagnostic and therapeutic relevance.

CONCLUSIONS

VRET can broaden the psychotherapy options for anxiety disorders. Encouraging results of VR-based treatments for psychosis and PTSD indicate the need for further research concerning its effectiveness and safety. In the field of substance use disorders, evaluation of clinical-orientated VR applications is needed.

Computational analyses identify addiction help-seeking behaviors on the social networking website Reddit: Insights into online social interactions and addiction support communities

INTRODUCTION

Although social connection to others with lived addiction experiences is a strong predictor of long-term recovery from substance use disorders (SUD), the COVID-19 pandemic greatly altered global abilities to physically connect with other people. Evidence suggests online forums for people with SUD may serve as a sufficient proxy for social connection, however efficacy of online spaces as addiction treatment adjuncts remains empirically understudied.

PURPOSE

The purpose of this study is to analyze a collection of Reddit posts germane to addiction and recovery collected between March-August 2022.

METHODS

We collected (n = 9,066) Reddit posts (1) r/addiction; (2) r/DecidingToBeBetter, (3) r/SelfImprovement, (4) r/OpitatesRecovery, (5) r/StopSpeeding, (6) r/RedditorsInRecovery, and (7) r/StopSmoking subreddits. We applied several classes of natural language processing (NLP) methods to analyze and visualize our data including term frequency inverse document frequency (TF-IDF) calculations, k-means clustering, and principal components analysis (PCA). We also applied a Valence Aware Dictional and sEntiment [sic] Reasoner (VADER) sentiment analysis to determine affect in our data.

RESULTS

Our analyses revealed three distinct clusters: (1) Personal addiction struggle, or sharing one's recovery journey (n = 2,520), (2) Giving advice, or offering counseling based on first-hand experiences (n = 3,885), and (3) Seeking advice, or asking for support or advice related to addiction (n = 2,661).

DISCUSSION & CONCLUSION

Addiction, SUD, and recovery dialogue on Reddit is exceedingly robust. Much of the content mirrors tenets for established addiction-recovery programs, which suggests Reddit, and other social networking websites, may serve as efficient tools to promote social connection among people with SUD.

The Effectiveness of Virtual Reality Interventions on Smoking, Nutrition, Alcohol, Physical Activity and/or Obesity Risk Factors: A Systematic Review

To our knowledge, no systematic reviews have examined the effectiveness of virtual reality (VR) interventions across all smoking, nutrition, alcohol, physical activity, and/or obesity (SNAPO) risk factors. This systematic review assessed the effectiveness of VR interventions on reducing SNAPO risks compared to control groups or other interventions. MEDLINE, EMBASE, Scopus, PsycINFO, and CENTRAL were searched to identify eligible studies published to 7 October 2021. Two reviewers independently completed screening, data extraction and quality assessment. Twenty-six studies were included, five on smoking, twelve on physical activity (PA), six on obesity, one on PA and obesity, one on obesity and nutrition, and one on obesity, nutrition and PA. VR was effective for smoking cessation in three studies and for smoking reduction in four studies. Seven studies had significantly higher PA in the VR group, and one study found significantly higher PA in a comparator group. Two studies showed VR was more effective at reducing BMI or weight than comparators. Three multiple health risks studies showed mixed results. The remaining studies found no significant difference between VR and control/comparators. VR appears promising for the treatment of smoking, nutrition, PA, and obesity risks; however, further randomised trials are needed.

Developing the Rationale for Including Virtual Reality in Cognitive Rehabilitation and Exercise Training Approaches for Managing Cognitive Dysfunction in MS

Cognitive impairment is a common and detrimental consequence of multiple sclerosis (MS) and current rehabilitation methods are insufficient. Cognitive rehabilitation (CR) and exercise training (ET) are the most promising behavioral approaches to mitigate cognitive deficits, but effects are small and do not effectively translate to improvements in everyday function. This article presents a conceptual framework supporting the use of virtual reality (VR) as an ideal, common adjuvant traditional CR and ET in MS. VR could strengthen the effects of CR and ET by increasing sensory input and promoting multisensory integration and processing during rehabilitation. For ET specifically, VR can also help incorporate components of CR into exercise sessions. In addition, VR can enhance the transfer of cognitive improvements to everyday functioning by providing a more ecologically valid training environment. There is a clear interest in adding VR to traditional rehabilitation techniques for neurological populations, a stronger body of evidence of this unique approach is needed in MS. Finally, to better understand how to best utilize VR in rehabilitation for cognitive deficits in MS, more systematic research is needed to better understand the mechanism(s) of action of VR with CR and ET.