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Benvegnù G, Perotti S, Vegher A, Chiamulera C. Virtual Reality Environmental Enrichment Effects on Craving for Cigarette in Smokers. Games Health J 2024. [PMID: 38985569 DOI: 10.1089/g4h.2023.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024] Open
Abstract
Background: Preclinical studies suggested the exposure to environmental enrichment (EE) as an intervention able to prevent or reduce nicotine-taking and nicotine-seeking behaviors. Virtual reality (VR) may help to test the effects of EE in smokers in a reproducible and feasible manner. Materials and Methods: In the present study, 31 smokers (14 women) were divided into two groups: (1) exposure to a virtual EE (VR-EE) and (2) exposure to a virtual neutral environment (VR-NoEE). Cigarette craving was assessed as basal and evoked, at different timepoints during the session. Behavior activity during VR exposure, mood, and subjective measures were also collected. Results: EE exposure in VR significantly reduced craving scores from basal timepoint. This was not observed in the VR-NoEE group, which significantly increased craving compared with values at neutral scenario. When both groups were exposed to smoking-related VR scenario, the VR-EE group showed an increased craving compared with previous timepoint up to score values not different from those in the VR-NoEE group. A significant positive correlation between basal craving scores and interactive behavior with virtual smoking cues was observed in the VR-NoEE but not in the VR-EE group. Conclusion: These findings suggest that virtual EE might have an inhibitory effect in smokers on basal, but not on evoked cigarette craving. Noteworthily, the interactive activity correlation to craving scores in the VR-NoEE participants was not observed in the VR-EE group, adding further evidence that the enrichment simulation was nonetheless able to modify behavior in the smoking-related scenario.
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Affiliation(s)
- Giulia Benvegnù
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Samuele Perotti
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Alessia Vegher
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Cristiano Chiamulera
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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Courtney KE, Liu W, Andrade G, Schulze J, Doran N. Attentional Bias, Pupillometry, and Spontaneous Blink Rate: Eye Characteristic Assessment Within a Translatable Nicotine Cue Virtual Reality Paradigm. JMIR Serious Games 2024; 12:e54220. [PMID: 38952012 PMCID: PMC11220568 DOI: 10.2196/54220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/05/2024] [Accepted: 06/01/2024] [Indexed: 07/03/2024] Open
Abstract
Background Incentive salience processes are important for the development and maintenance of addiction. Eye characteristics such as gaze fixation time, pupil diameter, and spontaneous eyeblink rate (EBR) are theorized to reflect incentive salience and may serve as useful biomarkers. However, conventional cue exposure paradigms have limitations that may impede accurate assessment of these markers. Objective This study sought to evaluate the validity of these eye-tracking metrics as indicators of incentive salience within a virtual reality (VR) environment replicating real-world situations of nicotine and tobacco product (NTP) use. Methods NTP users from the community were recruited and grouped by NTP use patterns: nondaily (n=33) and daily (n=75) use. Participants underwent the NTP cue VR paradigm and completed measures of nicotine craving, NTP use history, and VR-related assessments. Eye-gaze fixation time (attentional bias) and pupillometry in response to NTP versus control cues and EBR during the active and neutral VR scenes were recorded and analyzed using ANOVA and analysis of covariance models. Results Greater subjective craving, as measured by the Tobacco Craving Questionnaire-Short Form, following active versus neutral scenes was observed (F1,106=47.95; P<.001). Greater mean eye-gaze fixation time (F1,106=48.34; P<.001) and pupil diameter (F1,102=5.99; P=.02) in response to NTP versus control cues were also detected. Evidence of NTP use group effects was observed in fixation time and pupillometry analyses, as well as correlations between these metrics, NTP use history, and nicotine craving. No significant associations were observed with EBR. Conclusions This study provides additional evidence for attentional bias, as measured via eye-gaze fixation time, and pupillometry as useful biomarkers of incentive salience, and partially supports theories suggesting that incentive salience diminishes as nicotine dependence severity increases.
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Affiliation(s)
| | - Weichen Liu
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla, CA, United States
| | - Gianna Andrade
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Jurgen Schulze
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla, CA, United States
| | - Neal Doran
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Veterans Affairs San Diego Healthcare System, La Jolla, CA, United States
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Benvegnù G, Semenzato M, Urbani A, Zanlorenzi I, Cibin M, Chiamulera C. Nature-based experience in Venetian lagoon: Effects on craving and wellbeing in addict residential inpatients. Front Psychol 2024; 15:1356446. [PMID: 38933590 PMCID: PMC11202661 DOI: 10.3389/fpsyg.2024.1356446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction It is known that exposure to the natural environment may positively modulate mental processes and behaviors; in particular, it can reduce stress, anxiety, and depressive symptoms. This suggests a potential integration of "nature experience" into the treatment for substance use disorder (SUD) since various types of addiction are associated with anxiety and depression. Considering that only one study has been reported to date in patients with alcohol use disorder, the effect of nature experience in SUD patients' needs to be further investigated. This study aimed to test the effects of exposure to a natural lagoon environment on craving and measures of wellbeing in SUD patients in comparison to exposure to an urban environment. Methods Twenty-four SUD patients were divided into three groups of eight participants and exposed to two walking sessions (interspersed with a 1-week wash-out period) in a natural environment typical of the Venetian lagoon, an Urban walk, or staying at the residential center based on a Latin-square design. Before and after each session, drug craving, mood, wellbeing, agency, openness to the future, and restorativeness were assessed. Results The Nature walk significantly decreased craving in participants compared to their pre-walk values, and compared to craving after the Urban walk, with the latter significantly increased vs. pre-walk values. The Nature walk significantly decreased negative mood and increased wellbeing and agency. Openness to the future and restorativeness measures showed significant improvement after the Nature walk compared to the Urban walk. On the other hand, craving scores after the Urban Walk positively correlated with negative mood and a Sense of Negative Agency values and negatively correlated with wellbeing scores. Discussion Our results confirm that "nature experience" may improve mood, wellbeing, attention, stress relief, openness, and sense of being active in SUD patients. Moreover, we also showed a specific effect on drug craving-a key symptom of SUD.
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Affiliation(s)
- Giulia Benvegnù
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | | | | | | | - Cristiano Chiamulera
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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Lehoux T, Porche CN, Capobianco A, Gervilla M, Lecuyer F, Anthouard J, Weiner L. Towards virtual reality exposure therapy for cocaine use disorder: A feasibility study of inducing cocaine craving through virtual reality. Addict Behav Rep 2024; 19:100549. [PMID: 38725607 PMCID: PMC11081783 DOI: 10.1016/j.abrep.2024.100549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/12/2024] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
Background Craving is a core symptom of cocaine use disorders (CUD). Inducing craving in exposure to substance cues is of relevant interest for numerous clinical applications. Virtual reality exposure (VRE) might be a promising candidate for improving cue-exposure paradigms but remains almost not studied for cocaine. This feasibility study's main aim is to assess whether VRE to cocaine cues is capable to induce cocaine craving compared with VRE to neutral cues. Methods We conducted a within-subjects controlled trial in which cocaine users performed 3 consecutive 10 mins-tasks: VRE to neutral and cocaine cues, and a relaxation-based resting procedure. The primary outcome was the change in Cocaine Craving Questionnaire-Brief (CCQ-Brief) scores between VRE to neutral and cocaine cues. Secondary outcomes included between-tasks changes in scores of cocaine craving, pleasant/unpleasant emotions as well as self-efficacy to cope with craving. Results We recruited 11 chronic cocaine users including mostly crack smokers (45 %), cocaine snorters (36 %) and injectors (18 %), with 73 % of participants meeting DSM-IV criteria for cocaine dependence and/or abuse. Non-parametrical sign tests indicated significant large increases of CCQ-Brief scores from neutral to cocaine cue-VRE (S(11) = 11, p < 0.01, Cliff's Δ = 0.65, 95 % CI: 0.17-0.88). Exploratory comparative analyses indicated significant changes after our post-cues VRE relaxation procedure, with cocaine craving and emotions restored to baseline. Conclusions VRE to cocaine cues was feasible and capable to induce cocaine craving in cocaine users. This second VRE-based cue-reactivity study in cocaine paves the way for unexplored research on VRE clinical applications for CUD.
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Affiliation(s)
- Thomas Lehoux
- Laboratoire de Psychologie des Cognitions, University of Strasbourg, 4 Rue Blaise Pascal, 67081 Strasbourg, France
- Laboratoire ICube, University of Strasbourg, 300 Boulevard Sébastien Brant, 67412 Illkirch, France
- Association Ithaque, 12 Rue Kuhn, 67000 Strasbourg, France
| | - Christelle Nithart Porche
- Psychiatry, Mental Health, and Addictology Department, Strasbourg University Hospital, 1 Place de l’Hôpital, 67091 Strasbourg, France
- Institut National de la Santé et de la Recherche Médicale, Unité de Recherche 1114, Cognitive Neuropsychology, and Pathophysiology of Schizophrenia, 67000 Strasbourg, France
| | - Antonio Capobianco
- Laboratoire ICube, University of Strasbourg, 300 Boulevard Sébastien Brant, 67412 Illkirch, France
| | - Miguel Gervilla
- Laboratoire ICube, University of Strasbourg, 300 Boulevard Sébastien Brant, 67412 Illkirch, France
| | - Flavien Lecuyer
- Laboratoire ICube, University of Strasbourg, 300 Boulevard Sébastien Brant, 67412 Illkirch, France
| | | | - Luisa Weiner
- Laboratoire de Psychologie des Cognitions, University of Strasbourg, 4 Rue Blaise Pascal, 67081 Strasbourg, France
- Psychiatry, Mental Health, and Addictology Department, Strasbourg University Hospital, 1 Place de l’Hôpital, 67091 Strasbourg, France
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Malbos E, Borwell B, Einig-Iscain M, Korchia T, Cantalupi R, Boyer L, Lancon C. Virtual reality cue exposure therapy for tobacco relapse prevention: a comparative study with standard intervention. Psychol Med 2023; 53:5070-5080. [PMID: 35924727 PMCID: PMC10476066 DOI: 10.1017/s0033291722002070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/16/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Successful interventions have been developed for smoking cessation although the success of smoking relapse prevention protocols has been limited. Cognitive behavioural therapy (CBT) in particular has been hampered by a high relapse rate. Because relapse can be due to conditions associated with tobacco consumption (such as drinking in bars with friends), virtual reality cue exposure therapy (VRCE) can be a potential tool to generate 3D interactive environments that simulate risk situations for relapse prevention procedures. METHODS To assess the effectiveness of VRCE with CBT, a comparative trial involving 100 smoking abstinent participants was designed with all required virtual environments (VE) created with an inexpensive graphic engine/game level editor. RESULTS Outcome measures confirmed the immersive and craving eliciting effect of these VEs. Results demonstrated that more participants in the VRCE group did not experience smoking relapse and that VRCE is at least as efficacious as traditional CBT in terms of craving reduction and decrease in nicotine dependence. Dropout and relapse rate in the VRCE group was noticeably lower than the CBT group. Aside from mood scores, no significant differences were found regarding the other scales. CONCLUSION The present clinical trial provides evidence that VRCE was effective in preventing smoking relapse. Improvement in technology and methodology for future research and applications is delineated.
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Affiliation(s)
- Eric Malbos
- Department of Adult Psychiatry, Conception University Hospital, Marseille, France
- Equipe Imothep, Institut Fresnel, UMR 7249, Aix-Marseille Université, CNRS, Ecole Centrale Marseille, Marseille, France
| | - Baptiste Borwell
- Department of Adult Psychiatry, Conception University Hospital, Marseille, France
| | - Mélodie Einig-Iscain
- Department of Adult Psychiatry, Conception University Hospital, Marseille, France
- Equipe Imothep, Institut Fresnel, UMR 7249, Aix-Marseille Université, CNRS, Ecole Centrale Marseille, Marseille, France
| | - Théo Korchia
- Department of Adult Psychiatry, Conception University Hospital, Marseille, France
| | - Robin Cantalupi
- Cognitive Psychology Lab, UMR 7290, Aix-Marseille University, Marseille, France
| | - Laurent Boyer
- CEReSS, EA 3279, Center, La Timone Faculty of Medicine, Aix-Marseille Université, Marseille, France
| | - Christophe Lancon
- Department of Adult Psychiatry, Conception University Hospital, Marseille, France
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Wiebe A, Kannen K, Selaskowski B, Mehren A, Thöne AK, Pramme L, Blumenthal N, Li M, Asché L, Jonas S, Bey K, Schulze M, Steffens M, Pensel MC, Guth M, Rohlfsen F, Ekhlas M, Lügering H, Fileccia H, Pakos J, Lux S, Philipsen A, Braun N. Virtual reality in the diagnostic and therapy for mental disorders: A systematic review. Clin Psychol Rev 2022; 98:102213. [PMID: 36356351 DOI: 10.1016/j.cpr.2022.102213] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 08/21/2022] [Accepted: 10/11/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Virtual reality (VR) technologies are playing an increasingly important role in the diagnostics and treatment of mental disorders. OBJECTIVE To systematically review the current evidence regarding the use of VR in the diagnostics and treatment of mental disorders. DATA SOURCE Systematic literature searches via PubMed (last literature update: 9th of May 2022) were conducted for the following areas of psychopathology: Specific phobias, panic disorder and agoraphobia, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders, dementia disorders, attention-deficit/hyperactivity disorder, depression, autism spectrum disorder, schizophrenia spectrum disorders, and addiction disorders. ELIGIBILITY CRITERIA To be eligible, studies had to be published in English, to be peer-reviewed, to report original research data, to be VR-related, and to deal with one of the above-mentioned areas of psychopathology. STUDY EVALUATION For each study included, various study characteristics (including interventions and conditions, comparators, major outcomes and study designs) were retrieved and a risk of bias score was calculated based on predefined study quality criteria. RESULTS Across all areas of psychopathology, k = 9315 studies were inspected, of which k = 721 studies met the eligibility criteria. From these studies, 43.97% were considered assessment-related, 55.48% therapy-related, and 0.55% were mixed. The highest research activity was found for VR exposure therapy in anxiety disorders, PTSD and addiction disorders, where the most convincing evidence was found, as well as for cognitive trainings in dementia and social skill trainings in autism spectrum disorder. CONCLUSION While VR exposure therapy will likely find its way successively into regular patient care, there are also many other promising approaches, but most are not yet mature enough for clinical application. REVIEW REGISTRATION PROSPERO register CRD42020188436. FUNDING The review was funded by budgets from the University of Bonn. No third party funding was involved.
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Affiliation(s)
- Annika Wiebe
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Kyra Kannen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Benjamin Selaskowski
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Aylin Mehren
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Ann-Kathrin Thöne
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lisa Pramme
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Nike Blumenthal
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Mengtong Li
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Laura Asché
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Stephan Jonas
- Institute for Digital Medicine, University Hospital Bonn, Bonn, Germany
| | - Katharina Bey
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Marcel Schulze
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Maria Steffens
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Max Christian Pensel
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Matthias Guth
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Felicia Rohlfsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Mogda Ekhlas
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Helena Lügering
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Helena Fileccia
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Julian Pakos
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Niclas Braun
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.
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Zamboni L, Toldo S, Fusina F, Mattiello M, Mannari V, Campagnari S, Schiavone V, Congiu A, Verlato G, Chiamulera C, Lugoboni F. Study protocol-Evoked craving in high-dose benzodiazepine users. Front Psychiatry 2022; 13:956892. [PMID: 36311534 PMCID: PMC9608779 DOI: 10.3389/fpsyt.2022.956892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Benzodiazepine (BDZ) abuse, especially concerning high doses of BDZs, is an impairing substance use disorder (SUD) that is often difficult to treat. Craving and cue reactivity (CR) are two important phenomena that have a prominent role in maintaining addiction and triggering relapses in BDZ abuse; nevertheless, they have rarely been addressed in scientific literature. The present study aims to fill these gaps by implementing a highly innovative virtual reality (VR) design to assess the impact of substance-related environmental cues on BDZ craving, as well as their influence on patients' affective states. Therefore, on one hand, this research will contribute to the assessment of VR feasibility in the study of these phenomena, and, on the other, it will help disentangle the role that CR and craving have on mood and attention, which are equally important factors to consider when treating SUDs. We will recruit a healthy control group and a patient group comprising people seeking treatment for BDZ detoxification. The experimental design will consist of the presentation of three VR scenarios, one neutral, one BDZ-related but without BDZ cues, and another with BDZ cues. The craving will be measured through a virtual analog scale (VAS); the Profile of Mood States (POMS) and Alcohol Attention Scale (AAS) questionnaires in a modified version will also be administered. We will additionally control for VR-induced feelings of sickness by administering the Simulator Sickness Questionnaire (SSQ), and the Presence Questionnaire (PQ) will be used to investigate participants' sense of presence in virtual environments. We expect patients to exhibit higher levels of craving, and that the craving will be higher after exposure to a cue-related virtual environment as compared to a neutral scenario.
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Affiliation(s)
- Lorenzo Zamboni
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico “G.B. Rossi”, Verona, Italy
- Department of Neurosciences, University of Verona, Verona, Italy
| | - Silvia Toldo
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Francesca Fusina
- Padova Neuroscience Center, University of Padua, Padua, Italy
- Department of General Psychology, University of Padua, Padua, Italy
| | - Matteo Mattiello
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico “G.B. Rossi”, Verona, Italy
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Vanessa Mannari
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Simone Campagnari
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico “G.B. Rossi”, Verona, Italy
| | - Valentina Schiavone
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Alessio Congiu
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico “G.B. Rossi”, Verona, Italy
| | - Giuseppe Verlato
- Diagnostics and Public Health-Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - Cristiano Chiamulera
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Fabio Lugoboni
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico “G.B. Rossi”, Verona, Italy
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Karch S, Krause D, Lehnert K, Konrad J, Haller D, Rauchmann BS, Maywald M, Engelbregt H, Adorjan K, Koller G, Reidler P, Karali T, Tschentscher N, Ertl-Wagner B, Pogarell O, Paolini M, Keeser D. Functional and clinical outcomes of FMRI-based neurofeedback training in patients with alcohol dependence: a pilot study. Eur Arch Psychiatry Clin Neurosci 2022; 272:557-569. [PMID: 34622344 PMCID: PMC9095551 DOI: 10.1007/s00406-021-01336-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 09/22/2021] [Indexed: 01/20/2023]
Abstract
Identifying treatment options for patients with alcohol dependence is challenging. This study investigates the application of real-time functional MRI (rtfMRI) neurofeedback (NF) to foster resistance towards craving-related neural activation in alcohol dependence. We report a double-blind, placebo-controlled rtfMRI study with three NF sessions using alcohol-associated cues as an add-on therapy to the standard treatment. Fifty-two patients (45 male; 7 female) diagnosed with alcohol dependence were recruited in Munich, Germany. RtfMRI data were acquired in three sessions and clinical abstinence was evaluated 3 months after the last NF session. Before the NF training, BOLD responses and clinical data did not differ between groups, apart from anger and impulsiveness. During NF training, BOLD responses of the active group were decreased in medial frontal areas/caudate nucleus, and increased, e.g. in the cuneus/precuneus and occipital cortex. Within the active group, the down-regulation of neuronal responses was more pronounced in patients who remained abstinent for at least 3 months after the intervention compared to patients with a relapse. As BOLD responses were comparable between groups before the NF training, functional variations during NF cannot be attributed to preexisting distinctions. We could not demonstrate that rtfMRI as an add-on treatment in patients with alcohol dependence leads to clinically superior abstinence for the active NF group after 3 months. However, the study provides evidence for a targeted modulation of addiction-associated brain responses in alcohol dependence using rtfMRI.
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Affiliation(s)
- Susanne Karch
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
| | - Daniela Krause
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany.
| | - Kevin Lehnert
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
| | - Julia Konrad
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
| | - Dinah Haller
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
| | - Boris-Stephan Rauchmann
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
- Department of Radiology, University Hospital LMU, Munich, Germany
| | - Maximilian Maywald
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
| | - Hessel Engelbregt
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
- Hersencentrum Mental Health Institute, Amsterdam, The Netherlands
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU, Munich, Germany
| | - Gabriele Koller
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
| | - Paul Reidler
- Department of Radiology, University Hospital LMU, Munich, Germany
| | - Temmuz Karali
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
- Department of Radiology, University Hospital LMU, Munich, Germany
| | - Nadja Tschentscher
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
| | - Birgit Ertl-Wagner
- Department of Radiology, University Hospital LMU, Munich, Germany
- Division of Neuroradiology, Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
| | - Marco Paolini
- Department of Radiology, University Hospital LMU, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
- Department of Radiology, University Hospital LMU, Munich, Germany
- Munich Center for Neurosciences (MCN), LMU, Munich, Germany
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Giordano R, Donati MA, Zamboni L, Fusina F, Primi C, Lugoboni F. Alter Game: A Study Protocol on a Virtual "Serious Game" for Relapse Prevention in Patients With Gambling Disorder. Front Psychiatry 2022; 13:854088. [PMID: 35432033 PMCID: PMC9010883 DOI: 10.3389/fpsyt.2022.854088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Cognitive behavioral therapy (CBT) is the most successful protocol in gambling disorder (GD) treatment. However, it presents some weaknesses, especially concerning relapse prevention (RP). RP is one of the most important therapeutic steps, aiming at managing cravings and to avoid future relapse increasing perceived self-efficacy. Encouraging results come from the blending of psychotherapy and virtual reality (VR), containing gambling cues. The goal of Alter Game (approved by the Ethical Commission, Prot. No. 69346) is verifying the efficacy of an innovative psychological treatment for GD based on the integration of traditional CBT therapy and an immersive VR cue exposure therapy using a serious virtual game, which is a game designed for purposes other than entertainment. RP in virtual cue-exposure therapy allows pathological gamblers to manage the urge to gamble and to avoid relapse by becoming aware of which internal and external triggers are related to craving. We hypothesize that the integrated intervention will be more effective than simple CBT with regard to self-efficacy, craving, and gambling-related distortions. Four virtual ecological environments were developed, and a virtual app, Exludo, interfaced with a computerized multiparametric acquisition system for biofeedback, was created. A sample of about 60 patients aged between 18 and 65 with GD referring to the Addiction Medicine Unit of Verona (Rossi Hospital) will be recruited. Patients will be randomly assigned to the CBT group (16 CBT sessions) or the CBT + VR group (8 CBT sessions + 8 VR cue-exposure therapy sessions). The MCMI-III, the BIS-11, and the SOGS will be used to evaluate inclusion and exclusion criteria, while the Gambling Related Cognitions Scale and the Multidimensional Gambling Self-Efficacy Scale will be used to verify changes as a function of the treatment. Craving will be evaluated through VAS, and psychophysiological variables will be assessed through biofeedback. A pre-test/post-test experimental design with a 1-month follow-up will be conducted. This study will examine an innovative psychotherapeutic protocol for GD treatment, and it will help in identifying new virtual tools to increase the efficacy of traditional therapeutic approaches that could also be applied to treat other addictions.
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Affiliation(s)
- Rosaria Giordano
- Department of Internal Medicine, Unit of Addiction Medicine, G.B. Rossi Hospital, Verona, Italy
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Maria Anna Donati
- Department of Neuroscience, Psychology, Drug, and Child's Health, Section of Psychology, University of Florence, Florence, Italy
| | - Lorenzo Zamboni
- Department of Internal Medicine, Unit of Addiction Medicine, G.B. Rossi Hospital, Verona, Italy
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Francesca Fusina
- Department of General Psychology, University of Padova, Padua, Italy
- Padova Neuroscience Center, University of Padova, Padua, Italy
| | - Caterina Primi
- Department of Neuroscience, Psychology, Drug, and Child's Health, Section of Psychology, University of Florence, Florence, Italy
| | - Fabio Lugoboni
- Department of Internal Medicine, Unit of Addiction Medicine, G.B. Rossi Hospital, Verona, Italy
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Wu X, Du J, Jiang H, Zhao M. Application of Digital Medicine in Addiction. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (SCIENCE) 2022; 27:144-152. [PMID: 34866856 PMCID: PMC8627382 DOI: 10.1007/s12204-021-2391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/20/2021] [Indexed: 10/29/2022]
Affiliation(s)
- Xiaojun Wu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030 China
| | - Jiang Du
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030 China
| | - Haifeng Jiang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030 China
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030 China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 201108 China
- CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Sciences, Shanghai, 200031 China
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11
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Liu W, Andrade G, Schulze J, Doran N, Courtney KE. Using Virtual Reality to Induce and Assess Objective Correlates of Nicotine Craving: Paradigm Development Study. JMIR Serious Games 2022; 10:e32243. [PMID: 35166685 PMCID: PMC8889474 DOI: 10.2196/32243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Craving is a clinically important phenotype for the development and maintenance of nicotine addiction. Virtual reality (VR) paradigms are successful in eliciting cue-induced subjective craving and may even elicit stronger craving than traditional picture-cue methods. However, few studies have leveraged the advances of this technology to improve the assessment of craving. OBJECTIVE This report details the development of a novel, translatable VR paradigm designed to both elicit nicotine craving and assess multiple eye-related characteristics as potential objective correlates of craving. METHODS A VR paradigm was developed, which includes three Active scenes with nicotine and tobacco product (NTP) cues present, and three Neutral scenes devoid of NTP cues. A pilot sample (N=31) of NTP users underwent the paradigm and completed subjective measures of nicotine craving, sense of presence in the VR paradigm, and VR-related sickness. Eye-gaze fixation time ("attentional bias") and pupil diameter toward Active versus Neutral cues, as well as spontaneous blink rate during the Active and Neutral scenes, were recorded. RESULTS The NTP Cue VR paradigm was found to elicit a moderate sense of presence (mean Igroup Presence Questionnaire score 60.05, SD 9.66) and low VR-related sickness (mean Virtual Reality Sickness Questionnaire score 16.25, SD 13.94). Scene-specific effects on attentional bias and pupil diameter were observed, with two of the three Active scenes eliciting greater NTP versus control cue attentional bias and pupil diameter (Cohen d=0.30-0.92). The spontaneous blink rate metrics did not differ across Active and Neutral scenes. CONCLUSIONS This report outlines the development of the NTP Cue VR paradigm. Our results support the potential of this paradigm as an effective laboratory-based cue-exposure task and provide early evidence of the utility of attentional bias and pupillometry, as measured during VR, as useful markers for nicotine addiction.
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Affiliation(s)
- Weichen Liu
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla, CA, United States
| | - Gianna Andrade
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Jurgen Schulze
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla, CA, United States
| | - Neal Doran
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Veterans Affairs San Diego Healthcare System, La Jolla, CA, United States
| | - Kelly E Courtney
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
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12
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Virtual reality: a powerful technology to provide novel insight into treatment mechanisms of addiction. Transl Psychiatry 2021; 11:617. [PMID: 34873146 PMCID: PMC8648903 DOI: 10.1038/s41398-021-01739-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/20/2021] [Accepted: 11/01/2021] [Indexed: 12/31/2022] Open
Abstract
Due to its high ecological validity, virtual reality (VR) technology has emerged as a powerful tool for mental health research. Despite the wide use of VR simulations in research on mental illnesses, the study of addictive processes through the use of VR environments is still at its dawn. In a systematic literature search, we identified 38 reports of research projects using highly immersive head-mounted displays, goggles, or CAVE technologies to provide insight into treatment mechanisms of addictive behaviors. So far, VR research has mainly addressed the roles of craving, psychophysiology, affective states, cognition, and brain activity in addiction. The computer-generated VR environments offer very realistic, dynamic, interactive, and complex real-life simulations requesting active participation. They create a high sense of immersion in users by combining stereoscopic three-dimensional visual, auditory, olfactory, and tactile perceptions, tracking systems responding to user movements, and social interactions. VR is an emerging tool to study how proximal multi-sensorial cues, contextual environmental cues, as well as their interaction (complex cues) modulate addictive behaviors. VR allows for experimental designs under highly standardized, strictly controlled, predictable, and repeatable conditions. Moreover, VR simulations can be personalized. They are currently refined for psychotherapeutic interventions. Embodiment, eye-tracking, and neurobiological factors represent novel future directions. The progress of VR applications has bred auspicious ways to advance the understanding of treatment mechanisms underlying addictions, which researchers have only recently begun to exploit. VR methods promise to yield significant achievements to the addiction field. These are necessary to develop more efficacious and efficient preventive and therapeutic strategies.
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Motschman CA, Tiffany ST. Combined smoking and alcohol cues: Effects on craving, drug-seeking, and consumption. Alcohol Clin Exp Res 2021; 45:1864-1876. [PMID: 34469584 DOI: 10.1111/acer.14662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Alcohol and cigarettes are commonly used together, but little is known about their joint motivational impact. Cue reactivity studies have customarily examined alcohol and smoking cues in isolation, despite the potential for cues to elicit stronger motivational responses when combined. This study used a validated cue reactivity procedure (Choice Behavior Under Cued Conditions) systematically to disentangle the separate and joint effects of alcohol and cigarette cues on substance use motivation. METHODS Participants were 110 adults (Mage = 34.0, SD = 10.8) who consumed both cigarettes and alcohol. Participants completed 40 cue reactivity trials with four in vivo cue types: water, alcohol, cigarette, and combined cigarette and alcohol. Participants rated their craving prior to receiving opportunities to spend real money to gain access to the cues. Spending larger amounts of money increased the probability that the substance(s) would be available for consumption. When granted access, participants took one cigarette puff and/or sip of the beverage. A multimethod approach assessed three key motivational indices: craving, drug-seeking (spending, latency to access the cue), and consumption (puff duration, alcohol consumed). Effects of cue type and rates of substance use (cigarettes per day, drinks per day, relative frequency of co-use) were assessed using hierarchical linear models. RESULTS Both alcohol and smoking cues enhanced cue-specific craving but not craving for the alternative substance. In a novel finding, combined cues elicited higher craving and greater spending than single-drug cues. All drug cues elicited greater spending than water cues, and spending was moderated by the relative frequency of co-use. CONCLUSIONS We found that combined alcohol and cigarette cues provoke more powerful craving and drug-seeking responses and, therefore, may be more motivationally potent among individuals who use multiple substances.
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Affiliation(s)
- Courtney A Motschman
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, New York, USA.,Department of Psychological Sciences, University of Missouri, Columbia, Columbia, Missouri, USA
| | - Stephen T Tiffany
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, New York, USA
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Langener S, Van Der Nagel J, van Manen J, Markus W, Dijkstra B, De Fuentes-Merillas L, Klaassen R, Heitmann J, Heylen D, Schellekens A. Clinical Relevance of Immersive Virtual Reality in the Assessment and Treatment of Addictive Disorders: A Systematic Review and Future Perspective. J Clin Med 2021; 10:3658. [PMID: 34441953 PMCID: PMC8396890 DOI: 10.3390/jcm10163658] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/10/2021] [Accepted: 08/14/2021] [Indexed: 02/02/2023] Open
Abstract
(1) Background: Virtual reality (VR) has been investigated in a variety of psychiatric disorders, including addictive disorders (ADs); (2) Objective: This systematic review evaluates the current evidence of immersive VR (using head-mounted displays) in the clinical assessment and treatment of ADs; (3) Method: PubMed and PsycINFO were queried for publications up to November 2020; (4) Results: We screened 4519 titles, 114 abstracts and 85 full-texts, and analyzed 36 articles regarding the clinical assessment (i.e., diagnostic and prognostic value; n = 19) and treatment (i.e., interventions; n = 17) of ADs. Though most VR assessment studies (n = 15/19) showed associations between VR-induced cue-reactivity and clinical parameters, only two studies specified diagnostic value. VR treatment studies based on exposure therapy showed no or negative effects. However, other VR interventions like embodied and aversive learning paradigms demonstrated positive findings. The overall study quality was rather poor; (5) Conclusion: Though VR in ADs provides ecologically valid environments to induce cue-reactivity and provide new treatment paradigms, the added clinical value in assessment and therapy remains to be elucidated before VR can be applied in clinical care. Therefore, future work should investigate VR efficacy in randomized clinical trials using well-defined clinical endpoints.
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Affiliation(s)
- Simon Langener
- Human Media Interaction, University of Twente, 7522 NB Enschede, The Netherlands; (J.V.D.N.); (R.K.); (D.H.)
- Tactus Addiction Centre, 7418 ET Deventer, The Netherlands;
- Nijmegen Institute for Scientist-Practitioners in Addiction, 6525 GD Nijmegen, The Netherlands; (W.M.); (B.D.); (L.D.F.-M.); (J.H.); (A.S.)
| | - Joanne Van Der Nagel
- Human Media Interaction, University of Twente, 7522 NB Enschede, The Netherlands; (J.V.D.N.); (R.K.); (D.H.)
- Tactus Addiction Centre, 7418 ET Deventer, The Netherlands;
- Nijmegen Institute for Scientist-Practitioners in Addiction, 6525 GD Nijmegen, The Netherlands; (W.M.); (B.D.); (L.D.F.-M.); (J.H.); (A.S.)
| | - Jeannette van Manen
- Tactus Addiction Centre, 7418 ET Deventer, The Netherlands;
- Nijmegen Institute for Scientist-Practitioners in Addiction, 6525 GD Nijmegen, The Netherlands; (W.M.); (B.D.); (L.D.F.-M.); (J.H.); (A.S.)
| | - Wiebren Markus
- Nijmegen Institute for Scientist-Practitioners in Addiction, 6525 GD Nijmegen, The Netherlands; (W.M.); (B.D.); (L.D.F.-M.); (J.H.); (A.S.)
- IrisZorg Addiction Care, 6835 HZ Arnhem, The Netherlands
| | - Boukje Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction, 6525 GD Nijmegen, The Netherlands; (W.M.); (B.D.); (L.D.F.-M.); (J.H.); (A.S.)
- Radboud University Medical Centre, 6525 GC Nijmegen, The Netherlands
- Novadic-Kentron, Network for Addiction Treatment Service, 5261 LX Vught, The Netherlands
| | - Laura De Fuentes-Merillas
- Nijmegen Institute for Scientist-Practitioners in Addiction, 6525 GD Nijmegen, The Netherlands; (W.M.); (B.D.); (L.D.F.-M.); (J.H.); (A.S.)
- Novadic-Kentron, Network for Addiction Treatment Service, 5261 LX Vught, The Netherlands
| | - Randy Klaassen
- Human Media Interaction, University of Twente, 7522 NB Enschede, The Netherlands; (J.V.D.N.); (R.K.); (D.H.)
| | - Janika Heitmann
- Nijmegen Institute for Scientist-Practitioners in Addiction, 6525 GD Nijmegen, The Netherlands; (W.M.); (B.D.); (L.D.F.-M.); (J.H.); (A.S.)
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, 9712 CP Groningen, The Netherlands
| | - Dirk Heylen
- Human Media Interaction, University of Twente, 7522 NB Enschede, The Netherlands; (J.V.D.N.); (R.K.); (D.H.)
| | - Arnt Schellekens
- Nijmegen Institute for Scientist-Practitioners in Addiction, 6525 GD Nijmegen, The Netherlands; (W.M.); (B.D.); (L.D.F.-M.); (J.H.); (A.S.)
- Radboud University Medical Centre, 6525 GC Nijmegen, The Netherlands
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Is Virtual Reality Cue Exposure a Promising Adjunctive Treatment for Alcohol Use Disorder? J Clin Med 2021; 10:jcm10132972. [PMID: 34279455 PMCID: PMC8268737 DOI: 10.3390/jcm10132972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 12/16/2022] Open
Abstract
This narrative review presents recent developments in virtual reality (VR)-based interventions for alcohol use disorders (AUDs). The latest advances in mental healthcare hail an imminent cyber revolution, ushering in novel treatment options, with immersive virtual technology at the very forefront of expected change. With an aim to (a) provide a background on VR use in mental healthcare of AUD patients, (b) summarize existing evidence on conventional approaches to the treatment of AUDs and a trending paradigm shift towards VR applications in their management, and (c) describe key issues and future directions in research on craving assessment and VR cue-induced therapy in AUDs, a search for experimental and meta-analytic evidence was performed in six databases: PubMed and EBSCO (Medline, ERIC, PsychINFO, Academic Search Ultimate, and Health Source: Nursing/Academic Edition). Pooled results were screened for eligibility, and relevant papers were selected for inclusion. The analysis revealed VR’s promising effects in the treatment of AUDs. Its remarkable potential to simulate cues underlying subsequent addictive behaviors makes its application in the assessment and treatment of AUDs an attractive alternative to researchers and clinicians alike. Nevertheless, more evidence is needed before virtual reality cue exposure therapy (VR-CET) can become a clinical standard of care.
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Benvegnù G, Tommasi F, Ferraro S, Libener E, Di Chio M, Bosi S, Zandonai T, Chiamulera C. Smokers "Context Reactivity" in Virtual Domestic Environments. Eur Addict Res 2021; 27:439-446. [PMID: 33940577 DOI: 10.1159/000515301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/12/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although the effects of proximal smoking cues have been widely studied in smokers, little is known on the features associated with background spatial context effect, that is, "context reactivity." The aim of this study was to investigate context reactivity exhibited by smokers in virtual cue-free domestic scenarios. METHODS Sixty-nine participants divided in 2 cohorts (33 smokers and 36 non-smokers) were exposed to a virtual reality session with 4 domestic room scenarios presented in a balanced order: bedroom, bathroom, kitchen, and living room. RESULTS We showed that (i) it is possible to elicit smoking craving in smokers in virtual reality, and (ii) these effects are room dependent and (iii) associated with a lower sense of presence; furthermore, (iv) smokers reported higher craving scores for alcohol and food in a room-dependent fashion compared to non-smokers. CONCLUSION Our study provides an experimental paradigm for assessing context reactivity in smokers and suggests a potential use for the identification of non-pharmacological interventions as a co-adjuvant of smoking cessation treatment.
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Affiliation(s)
- Giulia Benvegnù
- Department of General Psychology, University of Padua, Padua, Italy.,Department of Diagnostic and Public Health, Pharmacology Section, Neuropsychopharmacology Lab, University of Verona, Verona, Italy
| | - Francesco Tommasi
- Department of Diagnostic and Public Health, Pharmacology Section, Neuropsychopharmacology Lab, University of Verona, Verona, Italy
| | - Stefano Ferraro
- Department of Diagnostic and Public Health, Pharmacology Section, Neuropsychopharmacology Lab, University of Verona, Verona, Italy
| | - Elettra Libener
- Department of Diagnostic and Public Health, Pharmacology Section, Neuropsychopharmacology Lab, University of Verona, Verona, Italy
| | - Marzia Di Chio
- Department of Diagnostic and Public Health, Pharmacology Section, Neuropsychopharmacology Lab, University of Verona, Verona, Italy
| | - Sandra Bosi
- Italian League against Cancer (LILT), Reggio Emilia, Italy
| | - Thomas Zandonai
- Department of Pharmacology, Paediatrics and Organic Chemistry, Miguel Hernández University of Elche, Alicante, Spain
| | - Cristiano Chiamulera
- Department of Diagnostic and Public Health, Pharmacology Section, Neuropsychopharmacology Lab, University of Verona, Verona, Italy
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Tamburin S, Dal Lago D, Armani F, Turatti M, Saccà R, Campagnari S, Chiamulera C. Smoking-related cue reactivity in a virtual reality setting: association between craving and EEG measures. Psychopharmacology (Berl) 2021; 238:1363-1371. [PMID: 33263158 PMCID: PMC8062345 DOI: 10.1007/s00213-020-05733-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/23/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cue-reactivity is the array of responses that smokers exhibit when exposed to conditioned and contextual stimuli previously associated to substance use. The difficulty to experimentally recreate the complexity of smokers' spatial experience and context requires more ecological models. Virtual reality (VR) creates a state of immersion close to reality allowing controlled assessments of behavioral responses. To date, no studies investigated brain activation associated to smoking cue-reactivity in VR using electroencephalography (EEG). AIMS To investigate whether a VR cue-reactivity paradigm (a) may increase smoking craving, (b) is feasible with EEG recording, and (c) induces craving levels associated to EEG desynchronization. METHODS Smokers (N = 20) and non-smokers (N = 20) were exposed to neutral and smoking-related VR scenarios, without and with smoking conditioned stimuli, respectively. EEG was recorded from occipital and parietal leads throughout the sessions to assess alpha band desynchronization. Smoking and food craving and presence visual analogue scales (VAS) were assessed during the session. RESULTS To be smoker, but not non-smoker, significantly influenced smoking craving VAS induced by smoking cue VR but not by neutral VR. No significant food craving changes was observed during the VR sessions. The new finding was that EEG alpha band power in posterior leads was significantly increased by the smoking context scenario only in smokers, and that the degree of smoking (i.e., heavy vs. light) was significantly associated to this neurophysiological measure. CONCLUSIONS This study demonstrated, for the first time, the feasibility of EEG recording in a VR setting, suggesting that EEG desynchronization may be a neurophysiological marker of smoking cue-reactivity.
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Affiliation(s)
- Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, I-37134, Verona, Italy.
| | - Denise Dal Lago
- Department of Diagnostic and Public Health, University of Verona, Piazzale Scuro 10, I-37134, Verona, Italy
| | - Federica Armani
- Department of Diagnostic and Public Health, University of Verona, Piazzale Scuro 10, I-37134, Verona, Italy
| | - Marco Turatti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, I-37134, Verona, Italy
| | - Riccardo Saccà
- Department of Diagnostic and Public Health, University of Verona, Piazzale Scuro 10, I-37134, Verona, Italy
| | - Simone Campagnari
- Department of Diagnostic and Public Health, University of Verona, Piazzale Scuro 10, I-37134, Verona, Italy
| | - Cristiano Chiamulera
- Department of Diagnostic and Public Health, University of Verona, Piazzale Scuro 10, I-37134, Verona, Italy.
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Segawa T, Baudry T, Bourla A, Blanc JV, Peretti CS, Mouchabac S, Ferreri F. Virtual Reality (VR) in Assessment and Treatment of Addictive Disorders: A Systematic Review. Front Neurosci 2020; 13:1409. [PMID: 31998066 PMCID: PMC6965009 DOI: 10.3389/fnins.2019.01409] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/12/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Substance Use Disorder (SUD) and behavioral addictions are common and require a multidisciplinary approach. New technologies like Virtual Reality could have the potential to improve assessment and treatment of these disorders. Objective: In the present paper, we therefore present an overview of Virtual Reality (Head Mounted Devices) in the field of addiction medicine for craving assessment and treatment. Method: We conducted a systematic review by querying PubMed database for the titles of articles published up to March 2019 with the terms [virtual] AND [addictive] OR [addiction] OR [substance] OR [alcohol] OR [cocaine] OR [cannabis] OR [opioid] OR [tobacco] OR [nicotine] OR [methamphetamine] OR [gaming] OR [gambling]. Results: We screened 319 abstracts and analyzed 37 articles, dividing them into two categories, the first for assessment of cue reactivity (craving, psychophysiological response and attention to cue) and the second for intervention, each drug (nicotine, cocaine, alcohol, cannabis, gambling) being detailed within each category. Conclusions: This overview suggest that VR provide benefits in the assessment and treatment of substance use disorders and behavior addictions and achieve high levels of ecological validity. While, craving provocation in VR is effective across addiction disorders, treatments based exclusively on virtual exposure to drug related cues as shown heterogenous results.
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Affiliation(s)
- Tomoyuki Segawa
- Department of Psychiatry, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Thomas Baudry
- Department of Psychiatry, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Alexis Bourla
- Department of Psychiatry, Hôpital Saint-Antoine, Sorbonne Université, Paris, France.,Jeanne d'Arc Hospital, INICEA Group, Saint-Mandé, France
| | - Jean-Victor Blanc
- Department of Psychiatry, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | | | - Stephane Mouchabac
- Department of Psychiatry, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Florian Ferreri
- Department of Psychiatry, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
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Miller LC, Shaikh SJ, Jeong DC, Wang L, Gillig TK, Godoy CG, Appleby PR, Corsbie-Massay CL, Marsella S, Christensen JL, Read SJ. Causal Inference in Generalizable Environments: Systematic Representative Design. PSYCHOLOGICAL INQUIRY 2020; 30:173-202. [PMID: 33093760 PMCID: PMC7577318 DOI: 10.1080/1047840x.2019.1693866] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Causal inference and generalizability both matter. Historically, systematic designs emphasize causal inference, while representative designs focus on generalizability. Here, we suggest a transformative synthesis - Systematic Representative Design (SRD) - concurrently enhancing both causal inference and "built-in" generalizability by leveraging today's intelligent agent, virtual environments, and other technologies. In SRD, a "default control group" (DCG) can be created in a virtual environment by representatively sampling from real-world situations. Experimental groups can be built with systematic manipulations onto the DCG base. Applying systematic design features (e.g., random assignment to DCG versus experimental groups) in SRD affords valid causal inferences. After explicating the proposed SRD synthesis, we delineate how the approach concurrently advances generalizability and robustness, cause-effect inference and precision science, a computationally-enabled cumulative psychological science supporting both "bigger theory" and concrete implementations grappling with tough questions (e.g., what is context?) and affording rapidly-scalable interventions for real-world problems.
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Facilitated attention for gambling cues in adolescent problem gamblers: An experimental study. J Affect Disord 2019; 252:39-46. [PMID: 30978623 DOI: 10.1016/j.jad.2019.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/20/2019] [Accepted: 04/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Studies investigating attentional biases in gambling have observed that problem gamblers' attention is biased toward gambling cues. Despite the increase of gambling among adolescents, to date, no study has ever examined the role of attentional bias in adolescent gambling, as well as the relationships between adolescent gambling severity, craving, and alcohol use. METHODS The present study comprised 87 adolescent participants. Based on South Oaks Gambling Screen Revised for Adolescents (SOGS-RA) scores, participants were assigned to non-problem or problem gamblers groups. Participants performed a modified Posner Task (with cue presentation times at 100 and 500 ms) to assess attentional biases. Following the experiment, participants completed the Gambling Craving Scale (GACS) and the Alcohol Use Disorders Identification Test (AUDIT). RESULTS Compared to non-problem gamblers, problem gamblers displayed facilitation bias for gambling cues at 500 ms and reported higher levels of craving and alcohol consumption. Results also indicated that alcohol use correlated with facilitation bias. LIMITATIONS The recruitment of a predominantly male sample and the use of an indirect measure of attentional bias may have affected the findings concerning attentional processes. CONCLUSIONS The present study provides the first empirical evidence of attentional processes in adolescent gambling, and confirms the role of attentional biases, craving, and alcohol use being associated factors in adolescent problem gambling. The results of the present study stress the importance of attentional biases in the initial stages of problem gambling and suggest the need for clinical interventions aimed at reducing attentional bias before they became automatic. Overall, the present study stressed the role of attentional bias as both facilitator and a consequence of gambling involvement.
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Metcalf M, Rossie K, Stokes K, Tallman C, Tanner B. Virtual Reality Cue Refusal Video Game for Alcohol and Cigarette Recovery Support: Summative Study. JMIR Serious Games 2018; 6:e7. [PMID: 29661748 PMCID: PMC5928331 DOI: 10.2196/games.9231] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 02/23/2018] [Accepted: 03/13/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND New technologies such as virtual reality, augmented reality, and video games hold promise to support and enhance individuals in addiction treatment and recovery. Quitting or decreasing cigarette or alcohol use can lead to significant health improvements for individuals, decreasing heart disease risk and cancer risks (for both nicotine and alcohol use), among others. However, remaining in recovery from use is a significant challenge for most individuals. OBJECTIVE We developed and assessed the Take Control game, a partially immersive Kinect for Windows platform game that allows users to counter substance cues through active movements (hitting, kicking, etc). METHODS Formative analysis during phase I and phase II guided development. We conducted a small wait-list control trial using a quasi-random sampling technique (systematic) with 61 participants in recovery from addiction to alcohol or tobacco. Participants used the game 3 times and reported on substance use, cravings, satisfaction with the game experience, self-efficacy related to recovery, and side effects from exposure to a virtual reality intervention and substance cues. RESULTS Participants found the game engaging and fun and felt playing the game would support recovery efforts. On average, reported substance use decreased for participants during the intervention period. Participants in recovery for alcohol use saw more benefit than those in recovery for tobacco use, with a statistically significant increase in self-efficacy, attitude, and behavior during the intervention. Side effects from the use of a virtual reality intervention were minor and decreased over time; cravings and side effects also decreased during the study. CONCLUSIONS The preliminary results suggest the intervention holds promise as an adjunct to standard treatment for those in recovery, particularly from alcohol use.
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Affiliation(s)
- Mary Metcalf
- Clinical Tools, Inc, Chapel Hill, NC, United States
| | - Karen Rossie
- Clinical Tools, Inc, Chapel Hill, NC, United States
| | - Katie Stokes
- Clinical Tools, Inc, Chapel Hill, NC, United States
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Gupta A, Scott K, Dukewich M. Innovative Technology Using Virtual Reality in the Treatment of Pain: Does It Reduce Pain via Distraction, or Is There More to It? PAIN MEDICINE 2017; 19:151-159. [DOI: 10.1093/pm/pnx109] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Silva MLD, Frère AF, Oliveira HJQD, Martucci Neto H, Scardovelli TA. Computer tool to evaluate the cue reactivity of chemically dependent individuals. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2017; 140:139-149. [PMID: 28254070 DOI: 10.1016/j.cmpb.2016.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 10/31/2016] [Accepted: 11/23/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Anxiety is one of the major influences on the dropout of relapse and treatment of substance abuse treatment. Chemically dependent individuals need (CDI) to be aware of their emotional state in situations of risk during their treatment. Many patients do not agree with the diagnosis of the therapist when considering them vulnerable to environmental stimuli related to drugs. This research presents a cue reactivity detection tool based on a device acquiring physiological signals connected to personal computer. Depending on the variations of the emotional state of the drug addict, alteration of the physiological signals will be detected by the computer tool (CT) which will modify the displayed virtual sets without intervention of the therapist. METHODS Developed in 3ds Max® software, the CT is composed of scenarios and objects that are in the habit of marijuana and cocaine dependent individual's daily life. The interaction with the environment is accomplished using a Human-Computer Interface (HCI) that converts incoming physiological signals indicating anxiety state into commands that change the scenes. Anxiety was characterized by the average variability from cardiac and respiratory rate of 30 volunteers submitted stress environment situations. To evaluate the effectiveness of cue reactivity a total of 50 volunteers who were marijuana, cocaine or both dependent were accompanied. RESULTS Prior to CT, the results demonstrated a poor correlation between the therapists' predictions and those of the chemically dependent individuals. After exposure to the CT, there was a significant increase of 73% in awareness of the risks of relapse. CONCLUSION We confirmed the hypothesis that the CT, controlled only by physiological signals, increases the perception of vulnerability to risk situations of individuals with dependence on marijuana, cocaine or both.
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Affiliation(s)
- Meire Luci da Silva
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de Filosofia e Ciências, Av. Hygino Muzzi Filho 737, Marília, São Paulo, Brazil.
| | - Annie France Frère
- Universidade Braz Cubas, Av. Francisco Rodrigues Filho 1233, Mogi das Cruzes, São Paulo, Brazil.
| | - Henrique Jesus Quintino de Oliveira
- Universidade de Mogi das Cruzes, Núcleo de Pesquisas Tecnológicas, Av. Dr. Cândido Xavier de Almeida e Souza 200, Mogi das Cruzes, São Paulo, Brazil.
| | - Helio Martucci Neto
- Universidade de Mogi das Cruzes, Núcleo de Pesquisas Tecnológicas, Av. Dr. Cândido Xavier de Almeida e Souza 200, Mogi das Cruzes, São Paulo, Brazil.
| | - Terigi Augusto Scardovelli
- Universidade de Mogi das Cruzes, Núcleo de Pesquisas Tecnológicas, Av. Dr. Cândido Xavier de Almeida e Souza 200, Mogi das Cruzes, São Paulo, Brazil.
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Nonnemaker J, Kim A, Shafer P, Loomis B, Hill E, Holloway J, Farrelly M. Influence of point-of-sale tobacco displays and plain black and white cigarette packaging and advertisements on adults: Evidence from a virtual store experimental study. Addict Behav 2016; 56:15-22. [PMID: 26785362 DOI: 10.1016/j.addbeh.2016.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 01/03/2016] [Accepted: 01/06/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION We examined the potential impact of banning tobacco displays and mandating plain packaging and cigarette advertisements at the point of sale (POS) on adult outcomes. METHODS A virtual convenience store was created with scenarios in which the tobacco product display was either fully visible (status quo) or enclosed behind a cabinet (display ban), and cigarette packs and advertisements were either in full color (status quo) or black and white, text only (plain). A national convenience sample of 1313 adult current smokers and recent quitters was randomized to 1 of 4 conditions and given a shopping task to complete in the virtual store. Main outcomes were participants' self-reported urge to smoke and tobacco purchase attempts in the virtual store. RESULTS Compared with recent quitters in the status quo conditions, recent quitters in the display ban condition had lower urges to smoke (β=-4.82, 95% CI=-8.16--1.49, p<0.01). Compared with current smokers in the status quo conditions, smokers in the display ban conditions were less likely to attempt to purchase cigarettes in the virtual store (OR=0.05, 95% CI=0.03-0.08, P<0.01). Smokers exposed to plain packs and ads were significantly less likely to attempt to purchase cigarettes (OR=0.31, 95% CI=0.20-0.47, P<0.01) than those exposed to color packs and ads. CONCLUSIONS Policies that ban the display of tobacco products or require plain packaging and advertising at the POS may help reduce adult smoking.
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Affiliation(s)
- James Nonnemaker
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709, USA.
| | - Annice Kim
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Paul Shafer
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Brett Loomis
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Edward Hill
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - John Holloway
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Matthew Farrelly
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709, USA
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Wulfert E, Harris K, Broussard J. The Role of Cross-Cue Reactivity in Coexisting Smoking and Gambling Habits. JOURNAL OF GAMBLING ISSUES 2016. [DOI: 10.4309/jgi.2016.32.3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cigarette smoking is the most common addictive behaviour co-occurring with problem gambling. Based on classical conditioning, smoking and gambling cues may acquire conditioned stimulus properties that elicit cravings for both behaviours. This study examined cross-cue reactivity in 75 men who were regular smokers, poker players or cigarette-smoking poker players. Participants were exposed to discrete cigarette, poker and neutral cues while skin conductance and psychological urges to smoke and gamble were measured. Results showed evidence of cross-cue reactivity based on skin conductance, and subjective response to smoking cues; subjective response to gambling cues was less clear. Smoking gamblers showed greater skin conductance reactivity to cues, and stronger subjective urges to smoke to smoking and gambling cues, compared to individuals who only smoked or only gambled. This study demonstrates evidence for cross-cue reactivity between a substance and a behavioural addiction, and the results encourage further research.
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Giovancarli C, Malbos E, Baumstarck K, Parola N, Pélissier MF, Lançon C, Auquier P, Boyer L. Virtual reality cue exposure for the relapse prevention of tobacco consumption: a study protocol for a randomized controlled trial. Trials 2016; 17:96. [PMID: 26892001 PMCID: PMC4759851 DOI: 10.1186/s13063-016-1224-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 02/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background Successful interventions have been developed for smoking cessation, but the success of smoking relapse prevention interventions has been limited. In particular, cognitive behavioural therapy (CBT) has been hampered by a high relapse rate. Because relapses can be due to the presence of conditions associated with tobacco consumption (such as drinking in bars with friends), virtual reality exposure therapy (VRET) can generate synthetic environments that represent risk situations for the patient in the context of relapse prevention. The primary objective of this study is to evaluate the effectiveness of CBT coupled with VRET, in comparison to CBT alone, in the prevention of smoking relapse. The secondary objectives are to assess the impact of CBT coupled with VRET on anxiety, depression, quality of life, self-esteem and addictive comorbidities (such as alcohol, cannabis, and gambling). A third objective examines the feasibility and acceptability of VR use considering elements such as presence, cybersickness and number of patients who complete the VRET program. Method/design The present study is a 14-month (2 months of therapy followed by 12 months of follow-up), prospective, comparative, randomized and open clinical trial, involving two parallel groups (CBT coupled with VRET versus CBT alone). The primary outcome is the proportion of individuals with tobacco abstinence at 6 months after the end of the therapy. Abstinence is defined by the total absence of tobacco consumption assessed during a post-test interview and with an apparatus that measures the carbon monoxide levels expired. A total of 60 individuals per group will be included. Discussion This study is the first to examine the efficacy of CBT coupled with VRET in the prevention of smoking relapse. Because VRET is simple to use and has a low cost, this interactive therapeutic method might be easily implemented in clinical practice if the study confirms its efficacy. Trial registration ClinicalTrials.gov Identifier: NCT02205060 (registered 25 July 2014). Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1224-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Camille Giovancarli
- Department of Psychiatry, La Conception University Hospital, 13005, Marseille, France.
| | - Eric Malbos
- Department of Psychiatry, La Conception University Hospital, 13005, Marseille, France.
| | - Karine Baumstarck
- Aix-Marseille University, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, 13005, Marseille, France.
| | - Nathalie Parola
- Department of Psychiatry, La Conception University Hospital, 13005, Marseille, France
| | | | - Christophe Lançon
- Department of Psychiatry, La Conception University Hospital, 13005, Marseille, France. .,Aix-Marseille University, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, 13005, Marseille, France.
| | - Pascal Auquier
- Aix-Marseille University, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, 13005, Marseille, France.
| | - Laurent Boyer
- Aix-Marseille University, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, 13005, Marseille, France.
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Smells like inhibition: The effects of olfactory and visual alcohol cues on inhibitory control. Psychopharmacology (Berl) 2016; 233:1331-7. [PMID: 26983413 PMCID: PMC4819591 DOI: 10.1007/s00213-016-4221-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/20/2016] [Indexed: 10/25/2022]
Abstract
RATIONALE How the smell of alcohol impacts alcohol-related thoughts and behaviours is unclear, though it is well-documented that alcohol-related stimuli and environments may trigger these. OBJECTIVES The current study, therefore, aimed to investigate the priming effects of both visual and olfactory alcohol cues on inhibitory control. METHOD Forty individuals (M age = 23.65, SD = 6.52) completed a go/no-go association task (GNAT) which measured reaction times, response accuracy and false alarm rates whilst being exposed to alcohol-related (or neutral) olfactory and visual cues. RESULTS Alcohol-related visual cues elicited lower false alarm rates, slower reaction times and higher accuracy rates relative to neutral pictorial cues. False alarm rates were significantly higher for those exposed to alcohol as opposed to neutral olfactory cues. CONCLUSIONS By highlighting that exposure to alcohol-related olfactory cues may impede response inhibition, the results indicate that exposure to such stimuli may contribute to the activation of cognitive responses which may drive consumption.
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Pericot-Valverde I, Germeroth LJ, Tiffany ST. The Use of Virtual Reality in the Production of Cue-Specific Craving for Cigarettes: A Meta-Analysis. Nicotine Tob Res 2015; 18:538-46. [PMID: 26453669 DOI: 10.1093/ntr/ntv216] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 09/15/2015] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The cue-reactivity procedure has demonstrated that smokers respond with increases in subjective craving in the presence of smoking-related cues. Virtual reality is an emerging mode of cue presentation for cue-reactivity research. Despite the successful implementation of virtual reality during the last decade, no systematic review has investigated the magnitude of effects across studies. METHODS This research systematically reviewed findings from studies using virtual reality in cigarette craving assessment. Eligible studies assessed subjective craving for cigarettes in smokers exposed to smoking-related and neutral environments. Cohen's d was used to assess differences in craving between smoking-related and nonsmoking-related virtual environments. A random effects approach was used to combine effect sizes. RESULTS A total of 18 studies involving 541 smokers was included in the final analyses. Environments with smoking-related cues produced significant increases in craving relative to environments without smoking-related cues. The mean overall effect size (Cohen's d) was 1.041 (SE = 0.12, 95% CI = 0.81 to 1.28, Z = 8.68, P < .001). CONCLUSIONS The meta-analysis suggested that presentations of smoking cues through virtual reality can produce strong increases in craving among cigarette smokers. This strong cue-reactivity effect, which was comparable in magnitude to the craving effect sizes found with more conventional modes of cue presentation, supports the use of virtual reality for the generation of robust cue-specific craving in cue-reactivity research.
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Affiliation(s)
| | - Lisa J Germeroth
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY
| | - Stephen T Tiffany
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY
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Dingle GA, Kelly PJ, Flynn LM, Baker FA. The influence of music on emotions and cravings in clients in addiction treatment: A study of two clinical samples. ARTS IN PSYCHOTHERAPY 2015. [DOI: 10.1016/j.aip.2015.05.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fatseas M, Serre F, Alexandre JM, Debrabant R, Auriacombe M, Swendsen J. Craving and substance use among patients with alcohol, tobacco, cannabis or heroin addiction: a comparison of substance- and person-specific cues. Addiction 2015; 110:1035-42. [PMID: 25688760 DOI: 10.1111/add.12882] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 01/21/2015] [Accepted: 02/10/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS It is well established that craving increases following exposure to substance-related 'cues', but the role of life-styles or substance use habits that are unique to each person remains poorly understood. This study examines the association of substance-specific and personal cues with craving and substance use in daily life. DESIGN Ecological momentary assessment was used during a 2-week period. SETTING Data were collected in a French out-patient addiction treatment centre. PARTICIPANTS A total of 132 out-patients beginning treatment for alcohol, tobacco, cannabis or opiate addiction were included. MEASUREMENTS Using mobile technologies, participants were questioned four times per day relative to craving, substance use and exposure to either substance-specific cues (e.g. seeing a syringe) or personal cues unique to that individual (e.g. seeing the specific person with whom the substance is used). FINDINGS Craving intensity was associated with the number of concurrently assessed substance-specific cues (t = 4.418, P < 0.001) and person-specific cues (t = 4.006, P < 0.001) when analysed jointly within the same model. However, only person-specific cues were associated with increases in craving over subsequent hours of the day (t = 2.598, P < 0.05). Craving intensity, in turn, predicted increases in later substance use (t = 4.076, P < 0.001). Causal mediation analyses demonstrated that the association of cues with later substance use was mediated by craving intensity (mediated effect = 0.007, 95% confidence interval = 0.004-0.011). CONCLUSIONS Unique person-specific cues appear to have a robust effect on craving addictive substances, and the duration of this association may persist longer than for more general substance-specific cues. Mobile technologies provide new opportunities for understanding these person-specific risk factors and for providing individually tailored interventions.
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Affiliation(s)
- Melina Fatseas
- Université Bordeaux, Bordeaux, France.,Laboratoire de psychiatrie/SANPSY, CNRS USR 3413, Bordeaux, France.,INCIA, CNRS UMR 5287, Bordeaux, France.,Pôle Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
| | - Fuschia Serre
- Université Bordeaux, Bordeaux, France.,Laboratoire de psychiatrie/SANPSY, CNRS USR 3413, Bordeaux, France.,Pôle Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
| | - Jean-Marc Alexandre
- Université Bordeaux, Bordeaux, France.,Laboratoire de psychiatrie/SANPSY, CNRS USR 3413, Bordeaux, France.,Pôle Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
| | - Romain Debrabant
- Université Bordeaux, Bordeaux, France.,Laboratoire de psychiatrie/SANPSY, CNRS USR 3413, Bordeaux, France.,Pôle Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
| | - Marc Auriacombe
- Université Bordeaux, Bordeaux, France.,Laboratoire de psychiatrie/SANPSY, CNRS USR 3413, Bordeaux, France.,Pôle Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France.,Center for Studies of Addiction, Department of psychiatry, Perelman School of Medicine, University of Pennsylvania, Phildelphia, PA, USA
| | - Joel Swendsen
- Université Bordeaux, Bordeaux, France.,INCIA, CNRS UMR 5287, Bordeaux, France.,Ecole Pratique des Hautes Etudes, Paris, France
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Brundage SB, Hancock AB. Real enough: using virtual public speaking environments to evoke feelings and behaviors targeted in stuttering assessment and treatment. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2015; 24:139-149. [PMID: 25569429 DOI: 10.1044/2014_ajslp-14-0087] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 10/20/2014] [Indexed: 06/04/2023]
Abstract
PURPOSE Virtual reality environments (VREs) are computer-generated, 3-dimensional worlds that allow users to experience situations similar to those encountered in the real world. The purpose of this study was to investigate VREs for potential use in assessing and treating persons who stutter (PWS) by determining the extent to which PWS's affective, behavioral, and cognitive measures in a VRE correlate with those same measures in a similar live environment. METHOD Ten PWS delivered speeches-first to a live audience and, on another day, to 2 virtual audiences (neutral and challenging audiences). Participants completed standard tests of communication apprehension and confidence prior to each condition, and frequency of stuttering was measured during each speech. RESULTS Correlational analyses revealed significant, positive correlations between virtual and live conditions for affective and cognitive measures as well as for frequency of stuttering. CONCLUSIONS These findings suggest that virtual public speaking environments engender affective, behavioral, and cognitive reactions in PWS that correspond to those experienced in the real world. Therefore, the authentic, safe, and controlled environments provided by VREs may be useful for stuttering assessment and treatment.
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Thompson-Lake DGY, Cooper KN, Mahoney JJ, Bordnick PS, Salas R, Kosten TR, Dani JA, De La Garza R. Withdrawal Symptoms and Nicotine Dependence Severity Predict Virtual Reality Craving in Cigarette-Deprived Smokers. Nicotine Tob Res 2014; 17:796-802. [PMID: 25475087 DOI: 10.1093/ntr/ntu245] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 11/05/2014] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Virtual reality (VR) has been shown to be effective in eliciting responses to nicotine cues in cigarette smokers. The primary aim of this study was to investigate whether cigarette-deprived smokers would exhibit increased craving and changes in heart rate when viewing cigarette related cues as compared to non-smoking cues in a VR environment, and the secondary aim was to assess the extent to which self-assessed measures of withdrawal and dependence correlated with VR craving. METHODS Nicotine-dependent cigarette smokers were recruited for a 2 day study. On Day 1, participants smoked as usual and on Day 2 were deprived from smoking overnight. On both days, participants completed self-assessment questionnaires on withdrawal, craving, and nicotine-dependence. Participants completed a VR session during the cigarette deprivation condition only (Day 2). During this session, they were exposed to active smoking and placebo (non-smoking) cues. RESULTS The data show that self-reported levels of "craving" (p < .01) and "thinking about cigarettes" (p < .0001) were significantly greater after exposure to the active cues versus non-smoking cues. Significant increases in heart rate were found for 3 of 4 active cues when compared to non-smoking cues (p < .05). Finally, significant positive correlations were found between self-reported craving prior to the VR session and craving induced by active VR cues (p < .01). CONCLUSIONS In this report, active VR cues elicited craving during cigarette deprivation. This is the first study to demonstrate that self-reported craving, withdrawal symptoms, and nicotine dependence severity predict cue-induced craving in the VR setting.
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Affiliation(s)
- Daisy G Y Thompson-Lake
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX;
| | - Kim N Cooper
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - James J Mahoney
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | | | - Ramiro Salas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Thomas R Kosten
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - John A Dani
- Department of Neuroscience, University of Pennsylvania, Philadelphia, PA
| | - Richard De La Garza
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
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Pericot-Valverde I, Secades-Villa R, Gutiérrez-Maldonado J, García-Rodríguez O. Effects of systematic cue exposure through virtual reality on cigarette craving. Nicotine Tob Res 2014; 16:1470-7. [PMID: 24962558 PMCID: PMC4342674 DOI: 10.1093/ntr/ntu104] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 05/21/2014] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Cigarette cravings have been associated with less successful attempts to quit smoking and a greater likelihood of relapse after smoking cessation. Background craving refers to a relatively steady and continuous experience of craving, while cue-induced craving refers to phases of intense craving triggered by cues associated with smoking. Cue exposure treatment (CET) involves repeated exposure to stimuli associated with substance use in order to reduce craving responses. However, mixed results have been found regarding the effect of CET on both types of craving. The aim of this study was to assess the effect of systematic virtual reality cue exposure treatment (VR-CET) on background and cue-induced cravings. METHODS Participants were 48 treatment-seeking smokers. The VR-CET consisted of prolonged exposure sessions to several interactive virtual environments. The VR-CET was applied once a week over 5 weeks. An individualized hierarchy of exposure was drawn up for each patient starting from the easiest virtual environment. Background and cue-induced cravings were recorded in each session. RESULTS Cue-induced craving decreased over each session as a result of prolonged exposure. VR-CET also reduced cue-induced and background cravings across the 5 sessions, showing a cumulative effect across the exposure sessions. CONCLUSIONS Our results evidenced the utility of VR-CET in reducing both types of cigarette craving. A combination of CET through VR with psychological treatments may improve current treatments for smoking cessation.
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Affiliation(s)
| | | | - José Gutiérrez-Maldonado
- Department of Personality, Assessment, and Psychological Treatments, University of Barcelona, Barcelona, Spain
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Monk RL, Heim D. A systematic review of the Alcohol norms literature: A focus on context. DRUGS: EDUCATION, PREVENTION AND POLICY 2014. [DOI: 10.3109/09687637.2014.899990] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Kim AE, Nonnemaker JM, Loomis BR, Shafer PR, Shaikh A, Hill E, Holloway JW, Farrelly MC. Influence of point-of-sale tobacco displays and graphic health warning signs on adults: evidence from a virtual store experimental study. Am J Public Health 2014; 104:888-95. [PMID: 24625149 DOI: 10.2105/ajph.2013.301723] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We tested the impact of banning tobacco displays and posting graphic health warning signs at the point of sale (POS). METHODS We designed 3 variations of the tobacco product display (open, enclosed [not visible], enclosed with pro-tobacco ads) and 2 variations of the warning sign (present vs absent) with virtual store software. In December 2011 and January 2012, we randomized a national convenience sample of 1216 adult smokers and recent quitters to 1 of 6 store conditions and gave them a shopping task. We tested for the main effects of the enclosed display, the sign, and their interaction on urge to smoke and tobacco purchase attempts. RESULTS The enclosed display significantly lowered current smokers' (B = -7.05; 95% confidence interval [CI] = -13.20, -0.91; P < .05) and recent quitters' (Β = -6.00, 95% CI = -11.00, -1.00; P < .01) urge to smoke and current smokers' purchase attempts (adjusted odds ratio = 0.06; 95% CI = 0.03, 0.11; P < .01). The warning sign had no significant main effect on study outcomes or interaction with enclosed display. CONCLUSIONS These data show that POS tobacco displays influence purchase behavior. Banning them may reduce cues to smoke and unplanned tobacco purchases.
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Affiliation(s)
- Annice E Kim
- Annice E. Kim, James M. Nonnemaker, Brett R. Loomis, Paul R. Shafer, Asma Shaikh, and Matthew C. Farrelly are with the Public Health Policy Research Program, and John W. Holloway is with the Discovery Science and Technology Division, RTI International, Research Triangle Park, NC. Edward Hill is with Tarheel Technologies, Durham, NC
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Kim K, Rosenthal MZ, Zielinski DJ, Brady R. Effects of virtual environment platforms on emotional responses. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2014; 113:882-893. [PMID: 24440136 DOI: 10.1016/j.cmpb.2013.12.024] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 11/14/2013] [Accepted: 12/17/2013] [Indexed: 06/03/2023]
Abstract
The goal of the current study was to investigate the effects of different virtual environment (VE) technologies (i.e., desktop, head mounted display, or fully immersive platforms) on emotional arousal and task performance. Fifty-three participants were recruited from a college population. Reactivity to stressful VEs was examined in three VE systems from desktop to high-end fully immersive systems. The experiment was a 3 (desktop system, head mounted display, and six wall system)×2 (high- and low-stressful VE) within subject design, with self-reported emotional arousal and valence, skin conductance, task performance, presence, and simulator sickness examined as dependent variables. Replicating previous studies, the fully immersive system induced the highest sense of presence and the head mounted display system elicited the highest amount of simulator sickness. Extending previous studies, the results demonstrated that VE platforms were associated with different patterns in emotional responses and task performance. Our findings suggest that different VE systems may be appropriate for different scientific purposes when studying stress reactivity using emotionally evocative tasks.
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Affiliation(s)
- Kwanguk Kim
- Department of Psychiatry and Behavioral Science, Duke University Medical Center, USA; Division of Computer Science and Engineering, Hanyang University, Republic of Korea
| | - M Zachary Rosenthal
- Department of Psychiatry and Behavioral Science, Duke University Medical Center, USA.
| | | | - Rachael Brady
- Department of Computer Science, Duke University, USA
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Remedios J, Woods C, Tardif C, Janak PH, Chaudhri N. Pavlovian-conditioned alcohol-seeking behavior in rats is invigorated by the interaction between discrete and contextual alcohol cues: implications for relapse. Brain Behav 2014; 4:278-89. [PMID: 24683519 PMCID: PMC3967542 DOI: 10.1002/brb3.216] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 12/21/2013] [Accepted: 01/05/2014] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Drug craving can be independently stimulated by cues that are directly associated with drug intake (discrete drug cues), as well as by environmental contexts in which drug use occurs (contextual drug cues). We tested the hypothesis that the context in which a discrete alcohol-predictive cue is experienced can influence how robustly that cue stimulates alcohol-seeking behavior. METHODS Male, Long-Evans rats received Pavlovian discrimination training (PDT) sessions in which one conditioned stimulus (CS+; 16 trials/session) was paired with ethanol (0.2 mL/CS+) and a second stimulus (CS-; 16 trials/session) was not. PDT occurred in a specific context, and entries into a fluid port where ethanol was delivered were measured during each CS. Next, rats were acclimated to an alternate (nonalcohol) context where cues and ethanol were withheld. Responses to the nonextinguished CS+ and CS- were then tested without ethanol in the alcohol-associated PDT context, the nonalcohol context or a third, novel context. RESULTS Across PDT the CS+ elicited more port entries than the CS-, indicative of Pavlovian discrimination learning. At test, the CS+ elicited more port entries than the CS- in all three contexts: however, alcohol seeking driven by the CS+ was more robust in the alcohol-associated context. In a separate experiment, extinguishing the context-alcohol association did not influence subsequent CS+ responding but reduced alcohol seeking during non-CS+ intervals during a spontaneous recovery test. CONCLUSION These results indicate that alcohol-seeking behavior driven by a discrete Pavlovian alcohol cue is strongly invigorated by an alcohol context, and suggest that contexts may function as excitatory Pavlovian conditioned stimuli that directly trigger alcohol-seeking behavior.
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Affiliation(s)
- Jessica Remedios
- Center for Studies in Behavioural Neurobiology/Groupe de recherche en neurobiologie comportementale, Department of Psychology, Concordia UniversityMontreal, Quebec, Canada
| | - Catherine Woods
- Center for Neural Science, New York UniversityNew York, New York
| | - Catherine Tardif
- Center for Studies in Behavioural Neurobiology/Groupe de recherche en neurobiologie comportementale, Department of Psychology, Concordia UniversityMontreal, Quebec, Canada
| | - Patricia H Janak
- Ernest Gallo Clinic & Research Center, University of California at San FranciscoEmeryville, California
- Department of Neurology, University of CaliforniaSan Francisco, California
- Wheeler Center for the Neurobiology of Addiction, University of California at San FranciscoSan Francisco, California
| | - Nadia Chaudhri
- Center for Studies in Behavioural Neurobiology/Groupe de recherche en neurobiologie comportementale, Department of Psychology, Concordia UniversityMontreal, Quebec, Canada
- Correspondence Nadia Chaudhri, CSBN/GRNC, Department of Psychology, Concordia University, 7141 Sherbrooke Street West, SP 244, Montreal, Quebec, H4B-1R6, Canada. Tel: 514-848-2424 (ext) 2216; Fax: 514-848-4545; E-mail:
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Peuker AC, Lopes FM, Menezes CB, Cunha SM, Bizarro L. Processamento implícito e dependência química: teoria, avaliação e perspectivas. PSICOLOGIA: TEORIA E PESQUISA 2013. [DOI: 10.1590/s0102-37722013000100002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pesquisas recentes têm investigado mecanismos cognitivos implícitos que influenciam a decisão e o comportamento de uso da droga, como viés atencional e reatividade a pistas. Tais respostas são eliciadas automaticamente, potencializando a vulnerabilidade à dependência e recaída ao uso da droga. Este estudo teve como objetivo apresentar a perspectiva teórica dos modelos de duplo-processamento dos comportamentos aditivos assim como discutir a influência dos processos automáticos no uso de drogas, suas formas de avaliação e técnicas que objetivam modificar diretamente tais processos. Os resultados sugerem que medidas implícitas possam avaliar os mecanismos automáticos mais acuradamente do que medidas explícitas. Diante disso, sugere-se que intervenções voltadas para a transformação das cognições implícitas sejam alternativas eficazes para o tratamento da dependência química.
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Ordoñana JR, González-Javier F, Gómez-Amor J. Psychophysiological reactivity to environmental tobacco smoke on smokers and non-smokers. Addict Behav 2012; 37:838-43. [PMID: 22465376 DOI: 10.1016/j.addbeh.2012.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 02/10/2012] [Accepted: 03/06/2012] [Indexed: 11/28/2022]
Abstract
Environmental tobacco smoke (ETS) is an air pollutant with a relevant impact on public health. In addition, ETS is a significant stimulus that may elicit different responses depending on previous experience and current status regarding smoking. Exposure to cigarette cues has been shown to be a reliable method for inducing subjective and physiological responses. However, the role of ETS as a stimulus has not received, to date, enough attention in the research literature. This study aimed to analyse both the autonomic and subjective responses of smokers and non-smokers to exposure to ETS. To that end, 41 non-smokers and 57 smokers were exposed to ETS, in a controlled laboratory setting. We measured the subjective perception of smoke, unpleasantness, heart rate and skin conductance to compare the reactions of smokers and non-smokers to ETS. Additionally, subjective tobacco craving after exposure was assessed for current smokers. We found different psychophysiological responses to ETS exposure for smokers and non-smokers. Smokers showed a generalised increase in autonomic activity, significantly greater than that of non-smokers. In addition, heart rate increase during exposure to ETS was positively correlated with subjective craving. Our data suggested that ETS was an important stimulus and acted as a relevant cue for smokers; it induced both psychophysiological reactions and subjective craving. Hence, this kind of stimulus within the cue-reactivity research paradigm may be useful for studying the effect of ETS on smokers' reactions, craving, quitting attempts, or relapse probabilities.
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Affiliation(s)
- Juan R Ordoñana
- Area of Psychobiology, Department of Human Anatomy and Psychobiology, University of Murcia, 30100 Espinardo-Murcia, Spain.
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