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Nègre F, Lemercier-Dugarin M, Gomet R, Pelissolo A, Malbos E, Romo L, Zerdazi EH. Study on the efficiency of virtual reality in the treatment of alcohol use disorder: study protocol for a randomized controlled trial : E-Reva. Trials 2024; 25:417. [PMID: 38937776 PMCID: PMC11212355 DOI: 10.1186/s13063-024-08271-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024] Open
Abstract
CONTEXT According to the World Health Organization, alcohol is a major global public health problem, leading to a significant increase in illness and death. To treat alcohol use disorders, new therapeutic tools are being promoted, among which virtual reality (VR) shows promise. Previous research has demonstrated the efficacy of VR in reducing alcohol cravings in patients, but there is a lack of data on its effectiveness in maintaining abstinence or reducing consumption in recently abstinent individuals. The E-Reva study aims to compare the efficacy of a treatment strategy combining virtual reality cue exposure therapy (VR-CET) and cognitive behavioral therapy (CBT) with conventional CBT in reducing alcohol consumption and craving in patients with alcohol use disorder (AUD). In addition to this primary objective, the study will compare the effects of VR-CET combined with CBT on anxiety, depression, rumination, and feelings of self-efficacy versus conventional CBT. METHODS This prospective randomized controlled trial will be conducted over 8 months in four addiction departments in France. It includes two parallel groups: i) the VR-CET + CBT group, and ii) the CBT-only group, which serves as a control group. Participants will be recruited by the investigating doctor in the addiction centers. The sample will consist of 156 patients diagnosed with AUD and abstinent for at least 15 days. Both treatment groups will participate in four group CBT sessions followed by four individual sessions: i) the VR-CET group will be exposed to virtual environments associated with alcohol-related stimuli, ii) the CBT-only group will receive traditional CBT sessions. After completion of the 8 sessions, patients will be followed up for 6 months. The primary outcome is the cumulative number of standard drinks consumed at 8 months, assessed using the TLFB method. DISCUSSION Despite the promise of VR-CET to reduce the desire to drink, the effect on alcohol consumption remains uncertain in the existing literature. Our protocol aims to address the limitations of previous research by increasing sample size, targeting consumption reduction, and incorporating neutral environments. E-Reva aims to enrich the literature on the use of VR in the treatment of AUD and open new perspectives for future interventions. TRIAL REGISTRATION ClinicalTrials.gov ID NCT06104176, Registered 2023/11/13 ( https://clinicaltrials.gov/study/NCT06104176?id=NCT06104176&rank=1 ). N° IDRCB: 2022-A02797-36. Protocol version 1.0, 12/05/2023.
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Affiliation(s)
- Fanny Nègre
- Laboratoire CLIPSYD, Université Paris Nanterre, 92000, Nanterre, France.
- DMU IMPACT, APHP, Hôpitaux Universitaires Henri-Mondor, Hôpital Albert-Chenevier, Service d'addictologie, 94010, Créteil, France.
| | | | - Romain Gomet
- DMU IMPACT, APHP, Hôpitaux Universitaires Henri-Mondor, Hôpital Albert-Chenevier, Service d'addictologie, 94010, Créteil, France
| | - Antoine Pelissolo
- DMU IMPACT, AP-HP, Université Paris-Est-Créteil (UPEC), Hôpitaux Universitaires Henri-MondorService de Psychiatrie, 94000, Créteil, France
- Université Paris-Est Créteil, INSERM U995, IMRB, Translational Neuropsychiatry Laboratory, 94010, Créteil, France
| | - Eric Malbos
- Psychiatry Service of Pr Lançon, CHU de Sainte Marguerite, Marseille, France
- Institut Fresnel Aix-Marseille Université, CNRS, Ecole Centrale Marseille, UMR, 72490, Marseille, France
| | - Lucia Romo
- Laboratoire CLIPSYD, Université Paris Nanterre, 92000, Nanterre, France
- APHP, Hôpital Universitaire Raymond Poincaré, 92380, Garches, France
- Université Paris Saclay, INSERM CESP, 1018 UPS, 94807, Villejuif, France
| | - El-Hadi Zerdazi
- DMU IMPACT, APHP, Hôpitaux Universitaires Henri-Mondor, Hôpital Albert-Chenevier, Service d'addictologie, 94010, Créteil, France
- Université Paris-Est Créteil, INSERM U995, IMRB, Translational Neuropsychiatry Laboratory, 94010, Créteil, France
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Nègre F, Lemercier-Dugarin M, Kahn-Lewin C, Gomet R, Zerdazi EHM, Zerhouni O, Romo L. Virtual reality efficiency as exposure therapy for alcohol use: A systematic literature review. Drug Alcohol Depend 2023; 253:111027. [PMID: 38006671 DOI: 10.1016/j.drugalcdep.2023.111027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/27/2023] [Accepted: 10/28/2023] [Indexed: 11/27/2023]
Abstract
Virtual reality is an immersive technology that can be used as a tool in the treatment of disorders linked to substance use disorders, such as alcohol use disorder. This systematic review of the literature examines the effectiveness of virtual reality as exposure therapy for heavy social drinkers, defined as people who regularly consume alcohol in a variety of social contexts, with or without a diagnosis of alcohol use disorder. The current review includes ten studies with a total of 377 participants. Most participants were adult men (61.03%), with an age average of 44.1 years [± 7.42] and alcohol use ranging from light to heavy. Although studies show heterogeneous results, the use of virtual reality cue exposure therapies has shown greater improvement in terms of craving reduction for patients suffering from alcohol use disorder. Studies have also shown that the realism of the virtual environment can influence levels of craving and anxiety, both in heavy social drinkers. In addition, the use of virtual reality has proven to increase feeling of self-efficacy and decrease the tendency to engage in automatic drinking behaviors. However, the review also mentions the necessity of larger research to determine the efficiency of virtual reality as a therapeutic treatment for alcohol use disorder, whilst considering comorbidities and treatment background, especially for resistant patients.
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Affiliation(s)
- Fanny Nègre
- Université Paris Nanterre, Laboratoire CLIPSYD, Nanterre, 92000 France; APHP, Hôpitaux Universitaires Henri Mondor, DMU IMPACT, Hôpital Albert Chenevier, Service d'addictologie, Créteil 94010, France.
| | - Maud Lemercier-Dugarin
- Université de Caen Normandie, Laboratoire de Psychologie Caen Normandie (LPCN, UR 7452), Caen 14000, France
| | - Chava Kahn-Lewin
- Université Paris Nanterre, Laboratoire CLIPSYD, Nanterre, 92000 France
| | - Romain Gomet
- APHP, Hôpitaux Universitaires Henri Mondor, DMU IMPACT, Hôpital Albert Chenevier, Service d'addictologie, Créteil 94010, France
| | - El-Hadi Mohammed Zerdazi
- APHP, Hôpitaux Universitaires Henri Mondor, DMU IMPACT, Hôpital Albert Chenevier, Service d'addictologie, Créteil 94010, France; Université Paris Est Créteil, INSERM U995, IMRB, Translational Neuropsychiatry laboratory, Créteil F-94010, France
| | - Oulmann Zerhouni
- Université Rouen Normandie, Normandie Univ, CRFDP UR 7475, Rouen F-76000, France; Laboratoire Parisien de Psychologie Sociale, EA 4386 (équipe PS2C), Nanterre Cedex 92001, France
| | - Lucia Romo
- Université Paris Nanterre, Laboratoire CLIPSYD, Nanterre, 92000 France; APHP, Hôpital Universitaire Raymond Poincaré, Garches 92380, France; Université Paris Saclay, INSERM CESP 1018 UPS, Villejuif 94807, France
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Kiyak C, Simonetti ME, Norton S, Deluca P. The efficacy of cue exposure therapy on alcohol use disorders: A quantitative meta-analysis and systematic review. Addict Behav 2023; 139:107578. [PMID: 36563480 DOI: 10.1016/j.addbeh.2022.107578] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 11/13/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cue exposure therapy (CET) techniques involves repeated and controlled exposures to alcohol stimuli which rest upon the well-established principles of Pavlovian extinction (Byrne et al., 2019). However, the efficacy of CET while treating alcohol use disorders (AUDs) is still a matter of debate. Therefore, we aimed to investigate the efficacy of CET on AUDs by using previous meta-analysis study on the same topic from Mellentin et al. (2017) as a base. METHODS A computer-assisted search of relevant articles identified 879 studies in Medline, PsycInfo and Embase, of which 11 studies (published between 1992 and 2019) were selected. Three outcome measures were extracted: alcohol consumption defined as drinks per day (drinking intensity) and alcohol reduction defined as drinking days and relapse (drinking frequency). This study is registered with PROSPERO (Registration no: #CRD42021259077). RESULTS The present meta-analytical review found small to medium effect on drinks per day (g = -0.35; 95 %CI -0.72 to 0.03), drinking days (g = -0.30; 95 %CI -0.54 to -0.06) and relapse (OR = -0.58; 95 %CI 0.29 to 1.15) while investigating the efficacy of CET on AUDs. GRADE assessment was used to evaluate the overall quality, and it was assessed as low. Regarding Risk of Bias, the studies in this systematic review were evaluated with "some concerns". CONCLUSION The present meta-analysis demonstrated that CET has small to medium effect on drinks per day, drinking days and relapse. Future research should strive to conduct larger scale multi-site CET trials with additional methodological innovations and increase retention.
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Affiliation(s)
- Ceyda Kiyak
- School of Psychology, University of East Anglia, Norwich, United Kingdom.
| | | | - Sam Norton
- Institute of Psychiatry Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Paolo Deluca
- Institute of Psychiatry Psychology & Neuroscience, King's College London, London, United Kingdom
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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: 16] [Impact Index Per Article: 8.0] [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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Gutiérrez-Maldonado J. The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders. J Clin Med 2022; 11:jcm11185358. [PMID: 36143005 PMCID: PMC9501337 DOI: 10.3390/jcm11185358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/06/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- José Gutiérrez-Maldonado
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Paseo Valle de Hebrón, 171, 08035 Barcelona, Spain
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