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Lehoux T, Capobianco A, Lacoste J, Rollier S, Mopsus Y, Melgire M, Lecuyer F, Gervilla M, Weiner L. Virtual reality cue-exposure therapy in reducing cocaine craving: the Promoting Innovative COgnitive behavioral therapy for Cocaine use disorder (PICOC) study protocol for a randomized controlled trial. Trials 2024; 25:421. [PMID: 38937824 PMCID: PMC11212420 DOI: 10.1186/s13063-024-08275-7] [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: 05/28/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Cocaine craving is a central symptom of cocaine use disorders (CUD). Virtual reality cue-exposure therapy for craving (VRCET) allows more immersive, realistic, and controllable exposure than traditional non-VR cue-exposure therapy (CET), whose efficacy is limited in treating substance use disorders. The purpose of this study is to evaluate the efficacy and acceptability of VRCET, as a stand-alone and add-on intervention (i.e., combined with cognitive therapy), compared to a picture-based CET (PCET), in reducing self-reported cocaine craving in inpatients hospitalized for CUD. METHODS Fifty-four inpatients hospitalized for CUD will be randomized in one of two intensive 3-week treatment arms: 10 meetings/2-week treatment of VRCET plus 5 meetings/1-week treatment of memory-focused cognitive therapy (MFCT; experimental arm), or 15 meetings/3-week treatment of PCET (active control arm). The Craving Experience Questionnaire (CEQ - F & S) will be used to assess the primary outcome, i.e., the post-treatment decrease of self-reported cocaine craving frequency (within the past 2 weeks) and intensity scores (in VR exposure to cocaine cues). Secondary endpoints include urinary, physiological, and self-reported cocaine use-related measures. Assessments are scheduled at pretreatment, after 2 weeks of treatment (i.e., VRCET vs. PCET), post-treatment (3 weeks, i.e., VRCET + MFCT vs. PCET), and at 1-month follow-up. Acceptability will be evaluated via (i) the Spatial Presence for Immersive Environments - Cybersickness along VRCET and (ii) the Client Satisfaction Questionnaires after 2 weeks of treatment and post-treatment. DISCUSSION This study will be the first to evaluate the acceptability and efficacy of VRCET for CUD, as a psychotherapeutic add-on, to reduce both cocaine craving frequency and intensity. Additionally, this study will provide evidence about the specific interest of VRCET, compared to a non-VR-based CET, as a cue reactivity and exposure paradigm for treating substance use disorders. TRIAL REGISTRATION NCT05833529 [clinicaltrials.gov]. Prospectively registered on April 17, 2023.
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Affiliation(s)
- T Lehoux
- Laboratoire de Psychologie Des Cognitions, University of Strasbourg, 4 Rue Blaise Pascal, 67081, Strasbourg, France.
- Laboratoire ICube - Equipe IGG, University of Strasbourg, 300 Boulevard Sébastien Brant, 67412, Illkirch, France.
| | - Antonio Capobianco
- Laboratoire ICube - Equipe IGG, University of Strasbourg, 300 Boulevard Sébastien Brant, 67412, Illkirch, France
| | - Jérôme Lacoste
- Service d'Addictologie, University Hospital of Martinique - Hôpital Pierre Zobda-Quitman (CHU de Martinique), CS 90632 - 97261, Fort-de-France Martinique, France
| | - Sloane Rollier
- Research Methodological Support (USMR), Délégation à La Recherche Clinique et à L'Innovation, University Hospital of Martinique - Hôpital Pierre Zobda-Quitman (CHU de Martinique), CS 90632 - 97261, Fort-de-France, Martinique, France
| | - Yann Mopsus
- Research Methodological Support (USMR), Délégation à La Recherche Clinique et à L'Innovation, University Hospital of Martinique - Hôpital Pierre Zobda-Quitman (CHU de Martinique), CS 90632 - 97261, Fort-de-France, Martinique, France
| | - Manuela Melgire
- Department of Addictology, CSAPA Saint-Esprit, Saint-Esprit Hospital (CH de Saint-Esprit), BP 176 Route du Petit-Bourg, 97270, Saint-Esprit, Martinique, France
| | - Flavien Lecuyer
- Laboratoire ICube - Equipe IGG, University of Strasbourg, 300 Boulevard Sébastien Brant, 67412, Illkirch, France
| | - Miguel Gervilla
- Laboratoire ICube - Equipe IGG, 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
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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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Thaysen-Petersen D, Hammerum SK, Vissing AC, Oestrich IH, Nordentoft M, Düring SW, Fink-Jensen A. Virtual reality-assisted cognitive behavioral therapy for patients with alcohol use disorder: a randomized feasibility study. Front Psychiatry 2024; 15:1337898. [PMID: 38419905 PMCID: PMC10899342 DOI: 10.3389/fpsyt.2024.1337898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Cognitive behavioral therapy (CBT) is an evidence-based treatment for alcohol use disorder (AUD). Exposure to high-risk situations in virtual reality (VR) has been suggested to have a potential therapeutical benefit, but no previous study has combined VR and CBT for AUD. We aimed to investigate the feasibility of using VR-simulated high-risk environments in CBT-based treatment of AUD. Methods We randomized ten treatment-seeking AUD-diagnosed individuals to three sessions of conventional CBT or VR-assisted CBT performed at two outpatient clinics in Denmark. In each session, patients randomized to VR-CBT were exposed to VR-simulations from a restaurant to induce authentic thoughts, emotions, physiological reactions, and craving for CBT purposes. The primary outcome measure was feasibility: Drop-out rate, psychological reactions, and simulator sickness. Secondary outcomes were assessment of preliminary short-term changes in alcohol consumption and craving from baseline to one-week and one-month follow-up. In addition, the study was conducted for training in operationalization of VR equipment, treatment manuals, and research questionnaires. Results The majority of patients completed all study visits (90%). VR induced authentic high-risk related thoughts, emotions, and physiological reactions that were considered relevant for CBT by patients and therapists. Four of five patients randomized to VR-CBT experienced cravings during VR simulations, and most of these patients (3/5) experienced mild simulator sickness during VR exposure. The preliminary data showed that patients receiving VR-CBT had more reduction in alcohol consumption than patients receiving conventional CBT at one week- (median 94% vs. 72%) and one-month follow-up (median 98% vs. 55%). Similar results were found regarding changes in cravings. Conclusion We demonstrated VR-CBT to be a feasible intervention for patients with AUD which supports continued investigations in a larger randomized clinical trial evaluating the efficacy of VR-CBT. Clinical trial registration https://www.clinicaltrials.gov/study/NCT04990765?cond=addiction%20CRAVR&rank=2, identifier NCT05042180.
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Affiliation(s)
- Daniel Thaysen-Petersen
- Mental Health Centre Copenhagen, Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Sigurd Krogh Hammerum
- Mental Health Centre Copenhagen, Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Anne-Cathrine Vissing
- Mental Health Centre Copenhagen, Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Irene Henriette Oestrich
- Mental Health Centre Sct. Hans, Roskilde, Mental Health Services, Capital Region of Denmark, Roskilde, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Signe Wegmann Düring
- Mental Health Centre Sct. Hans, Roskilde, Mental Health Services, Capital Region of Denmark, Roskilde, Denmark
- Outpatient Clinics, Novavi Foundation, Frederiksberg, Denmark
- Psychiatric Center Amager, Mental Health Services, Capitol Region Hospitals, Amager, Denmark
| | - Anders Fink-Jensen
- Mental Health Centre Copenhagen, Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Quaglieri A, Pizzo A, Cricenti C, Tagliaferri G, Frisari FV, Burrai J, Mari E, Lausi G, Giannini AM, Zivi P. Gambling and virtual reality: unraveling the illusion of near-misses effect. Front Psychiatry 2024; 15:1322631. [PMID: 38362030 PMCID: PMC10867214 DOI: 10.3389/fpsyt.2024.1322631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/10/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction Studying gambling behavior is a crucial element in reducing the impact of problem gambling. Nevertheless, most current research is carried out in controlled laboratory settings rather than real-life situations, which raises concerns about how applicable the findings are in the broader context. Virtual reality (VR) has proven to be a valuable tool and has been utilized in various experimental scenarios. A limited number of studies have employed VR to investigate gambling behaviors, and few have explored them in an older adolescent context. Methods This study examined the behavioral and physiological effects of gambling behavior, including problem gambling, gaming addiction, and risk-taking decision-making in a sample of 36 high-school students aged between 18 to 20 years using an ad-hoc constructed VR scenario designed to simulate a slot-machine platform. Results The behavioral results highlighted that participants reporting more problem gambling were sensitive to near-misses: i.e., they bet more after near-misses than after losses. This result may reflect the false belief that gamblers, after near-misses, are closer to winning. Physiological data showed that participants exhibited heart rate deceleration during the anticipation of the outcome, which has been suggested to represent a marker of feedback anticipation processing and hyposensitivity to losses. Discussion Overall, this study provides evidence for a new VR tool to assess gambling behaviors and new insights into gambling-related behavioral and physiological factors. Implications for the treatment of problem gambling are discussed.
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Affiliation(s)
| | - Alessandra Pizzo
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | | | | | - Francesca Valeria Frisari
- Department of Psychology of Development and Socialization Processes, Sapienza University of Rome, Rome, Italy
| | - Jessica Burrai
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Emanuela Mari
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Giulia Lausi
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Pierpaolo Zivi
- Department of Psychology, Sapienza University of Rome, Rome, Italy
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Lütt A, Tsamitros N, Wolbers T, Rosenthal A, Bröcker AL, Schöneck R, Bermpohl F, Heinz A, Beck A, Gutwinski S. An explorative single-arm clinical study to assess craving in patients with alcohol use disorder using Virtual Reality exposure (CRAVE)-study protocol. BMC Psychiatry 2023; 23:839. [PMID: 37964300 PMCID: PMC10647047 DOI: 10.1186/s12888-023-05346-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/03/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) belongs to the most burdensome clinical disorders worldwide. Current treatment approaches yield unsatisfactory long-term effects with relapse rates up to 85%. Craving for alcohol is a major predictor for relapse and can be intentionally induced via cue exposure in real life as well as in Virtual Reality (VR). The induction and habituation of craving via conditioned cues as well as extinction learning is used in Cue Exposure Therapy (CET), a long-known but rarely used strategy in Cognitive Behavioral Therapy (CBT) of AUD. VR scenarios with alcohol related cues offer several advantages over real life scenarios and are within the focus of current efforts to develop new treatment options. As a first step, we aim to analyze if the VR scenarios elicit a transient change in craving levels and if this is measurable via subjective and psychophysiological parameters. METHODS A single-arm clinical study will be conducted including n = 60 patients with AUD. Data on severity of AUD and craving, comorbidities, demographics, side effects and the feeling of presence in VR will be assessed. Patients will use a head-mounted display (HMD) to immerse themselves into three different scenarios (neutral vs. two target situations: a living room and a bar) while heart rate, heart rate variability, pupillometry and electrodermal activity will be measured continuously. Subjective craving levels will be assessed before, during and after the VR session. DISCUSSION Results of this study will yield insight into the induction of alcohol craving in VR cue exposure paradigms and its measurement via subjective and psychophysiological parameters. This might be an important step in the development of innovative therapeutic approaches in the treatment of patients with AUD. TRIAL REGISTRATION This study was approved by the Charité-Universitätsmedizin Berlin Institutional Review Board (EA1/190/22, 23.05.2023). It was registered on ClinicalTrials.gov (NCT05861843).
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Affiliation(s)
- A Lütt
- Psychiatric University Hospital Charité at St. Hedwig Hospital, 10115, Berlin, Germany.
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany.
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, 10117, Berlin, Germany.
- German Center for Mental Health (DZPG), partner site Berlin, Berlin, Germany.
| | - N Tsamitros
- Psychiatric University Hospital Charité at St. Hedwig Hospital, 10115, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - T Wolbers
- German Center for Neurodegenerative Diseases (DZNE), 39120, Magdeburg, Germany
| | - A Rosenthal
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany
| | - A L Bröcker
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany
| | - R Schöneck
- Salus Clinic Lindow, 16835, Lindow, Germany
| | - F Bermpohl
- Psychiatric University Hospital Charité at St. Hedwig Hospital, 10115, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany
| | - A Heinz
- Psychiatric University Hospital Charité at St. Hedwig Hospital, 10115, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany
- German Center for Mental Health (DZPG), partner site Berlin, Berlin, Germany
| | - A Beck
- Faculty of Health, Health and Medical University, 14471, Potsdam, Germany
| | - S Gutwinski
- Psychiatric University Hospital Charité at St. Hedwig Hospital, 10115, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany
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Larsen JK, Hollands GJ, Garland EL, Evers AWM, Wiers RW. Be more mindful: Targeting addictive responses by integrating mindfulness with cognitive bias modification or cue exposure interventions. Neurosci Biobehav Rev 2023; 153:105408. [PMID: 37758008 DOI: 10.1016/j.neubiorev.2023.105408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/01/2023] [Accepted: 09/22/2023] [Indexed: 09/29/2023]
Abstract
This review provides an overview of the most prominent neurocognitive effects of cognitive bias modification (CBM), cue-exposure therapy and mindfulness interventions for targeting addictive responses. It highlights the key insights that have stemmed from cognitive neuroscience and brain imaging research and combines these with insights from behavioural science in building a conceptual model integrating mindfulness with response-focused CBM or cue-exposure interventions. This furthers our understanding of whether and how mindfulness strategies may i) facilitate or add to the induced response-focused effects decreasing cue-induced craving, and ii) further weaken the link between craving and addictive responses. Specifically, awareness/monitoring may facilitate, and decentering may add to, response-focused effects. Combined awareness acceptance strategies may also diminish the craving-addiction link. The conceptual model presented in this review provides a specific theoretical framework to deepen our understanding of how mindfulness strategies and CBM or cue-exposure interventions can be combined to greatest effect. This is important in both suggesting a roadmap for future research, and for the further development of clinical interventions.
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Affiliation(s)
- Junilla K Larsen
- Behavioural Science Institute, Radboud University, PO Box 9104, 6500 HE Nijmegen, the Netherlands.
| | - Gareth J Hollands
- EPPI Centre, UCL Social Research Institute, University College London, UK
| | - Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah, Salt Lake City, USA
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Leiden University, NL, and Medical Delta, Leiden University, TU Delft and Erasmus University, UK
| | - Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT)-lab, Department of Psychology, University of Amsterdam and Centre for Urban Mental Health, University of Amsterdam, the Netherlands
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Thaysen-Petersen D, Hammerum SK, Vissing AC, Arnfred BT, Nordahl R, Adjorlu A, Nordentoft M, Oestrich IH, Düring SW, Fink-Jensen A. Virtual reality-assisted cognitive behavioural therapy for outpatients with alcohol use disorder (CRAVR): a protocol for a randomised controlled trial. BMJ Open 2023; 13:e068658. [PMID: 36990475 PMCID: PMC10069573 DOI: 10.1136/bmjopen-2022-068658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Alcohol use disorder (AUD) is a brain disorder linked to over 200 health conditions. Cognitive behavioural therapy (CBT) is considered the best practice in the treatment of AUD, but more than 60% of patients relapse within the first year after treatment. Psychotherapy combined with virtual reality (VR) has received increasing interest in the treatment of AUD. However, existing studies have primarily investigated the use of VR for cue reactivity. We therefore aimed to investigate the effect of VR-assisted CBT (VR-CBT). METHODS AND ANALYSIS This study is an assessor-blinded, randomised clinical trial being conducted at three outpatient clinics in Denmark. We will randomise 102 patients to 14 individual sessions of either manualised VR-CBT or CBT. The VR-CBT group will receive exposure to immersive high-risk VR situations from a pub, bar/party, restaurant, supermarket and at-home (30 videos) to activate high-risk-related beliefs and cravings for subsequent modification using CBT techniques. The treatment period is 6 months, and follow-up visits will be performed 3, 6, 9 and 12 months after inclusion. The primary outcome measure is the change in total alcohol consumption from baseline to 6 months after inclusion, measured with the Timeline Followback Method. Key secondary outcome measures include changes in the number of heavy drinking days, alcohol cravings, cognition, and symptoms of depression and anxiety. ETHICS AND DISSEMINATION Approval has been obtained by the research ethics committee in the Capital Region of Denmark (H-20082136) and the Danish Data Protection Agency (P-2021-217). All patients will receive both oral and written information about the trial and written informed consent will be obtained from each patient before inclusion. The study results will be disseminated in peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ClinicalTrial.gov, NCT05042180.
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Affiliation(s)
- Daniel Thaysen-Petersen
- Psychiatric Centre Copenhagen, Department of Neuroscience and Pharmacology, Capital Region of Denmark Mental Health Services, Kobenhavn, Hovedstaden, Denmark
| | - Sigurd Krogh Hammerum
- Psychiatric Centre Copenhagen, Department of Neuroscience and Pharmacology, Capital Region of Denmark Mental Health Services, Kobenhavn, Hovedstaden, Denmark
| | - Anne-Cathrine Vissing
- Psychiatric Centre Copenhagen, Department of Neuroscience and Pharmacology, Capital Region of Denmark Mental Health Services, Kobenhavn, Hovedstaden, Denmark
| | - Benjamin Thorup Arnfred
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Capital Region of Denmark Mental Health Services, Kobenhavn, Hovedstaden, Denmark
| | - Rolf Nordahl
- Multisensory Experience Lab, Department of Architecture and Media Technology, Aalborg Universitet, Copenhagen, Denmark
| | - Ali Adjorlu
- Multisensory Experience Lab, Department of Architecture and Media Technology, Aalborg Universitet, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Capital Region of Denmark Mental Health Services, Kobenhavn, Hovedstaden, Denmark
| | - Irene Henriette Oestrich
- Psychiatric Center Sct. Hans, Mental Health Services, Capitol Region Hospitals, Capital Region of Denmark Mental Health Services, Kobenhavn, Hovedstaden, Denmark
| | - Signe Wegmann Düring
- Psychiatric Center Sct. Hans, Mental Health Services, Capitol Region Hospitals, Capital Region of Denmark Mental Health Services, Kobenhavn, Hovedstaden, Denmark
| | - Anders Fink-Jensen
- Psychiatric Center Copenhagen, Rigshospitalet, Mental Health Services, Capitol Region Hospitals, Capital Region of Denmark Mental Health Services, Kobenhavn, Hovedstaden, Denmark
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Tsamitros N, Beck A, Sebold M, Schouler-Ocak M, Bermpohl F, Gutwinski S. [The application of virtual reality in the treatment of mental disorders]. DER NERVENARZT 2023; 94:27-33. [PMID: 36053303 PMCID: PMC9859917 DOI: 10.1007/s00115-022-01378-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Virtual reality (VR) enables immersion in an interactive digital world with realistic experiences, that can be applied for controlled and personalized interventions. This review summarizes the current research on VR in the treatment of mental disorders. METHODS Selective literature search in PubMed and Google Scholar. RESULTS An increasing number of publications report the therapeutic application of VR for the treatment of mental disorders. Most VR applications are based on established therapy approaches, such as exposure therapy. According to meta-analytic data, virtual exposure therapy (VRET) for specific phobia and agoraphobia with panic disorder is as effective as traditional in vivo exposure therapy. VRET for the treatment of social phobia is significantly more effective than waitlist and placebo control groups with, however, currently inconsistent metanalytic results when compared to in vivo exposure therapy. VRET for the treatment of posttraumatic stress disorder (PTSD) is similar in effectiveness compared to active psychotherapy. For psychosis, positive results have been reported for the VR-based treatment of auditory verbal hallucinations. For patients with a substance use disorder, VR can induce craving, with still unverified diagnostic and therapeutic relevance. CONCLUSIONS VRET can broaden the psychotherapy options for anxiety disorders. Encouraging results of VR-based treatments for psychosis and PTSD indicate the need for further research concerning its effectiveness and safety. In the field of substance use disorders, evaluation of clinical-orientated VR applications is needed.
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Affiliation(s)
- N. Tsamitros
- Psychiatrische Universitätsklinik der Charité – Universitätsmedizin Berlin im St. Hedwig-Krankenhaus/Institutsambulanz, Müllerstr. 56–58, 13349 Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - A. Beck
- Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland ,Fakultät Gesundheit, Health and Medical University, Campus Potsdam, Potsdam, Deutschland
| | - M. Sebold
- Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - M. Schouler-Ocak
- Psychiatrische Universitätsklinik der Charité – Universitätsmedizin Berlin im St. Hedwig-Krankenhaus/Institutsambulanz, Müllerstr. 56–58, 13349 Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - F. Bermpohl
- Psychiatrische Universitätsklinik der Charité – Universitätsmedizin Berlin im St. Hedwig-Krankenhaus/Institutsambulanz, Müllerstr. 56–58, 13349 Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - S. Gutwinski
- Psychiatrische Universitätsklinik der Charité – Universitätsmedizin Berlin im St. Hedwig-Krankenhaus/Institutsambulanz, Müllerstr. 56–58, 13349 Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
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9
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Zary N, Eysenbach G, VanDerNagel J, Heylen D. Immersive Virtual Reality Avatars for Embodiment Illusions in People With Mild to Borderline Intellectual Disability: User-Centered Development and Feasibility Study. JMIR Serious Games 2022; 10:e39966. [PMID: 36476721 PMCID: PMC9773028 DOI: 10.2196/39966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/22/2022] [Accepted: 10/31/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Immersive virtual reality (IVR) has been investigated as a tool for treating psychiatric conditions. In particular, the practical nature of IVR, by offering a doing instead of talking approach, could support people who do not benefit from existing treatments. Hence, people with mild to borderline intellectual disability (MBID; IQ=50-85) might profit particularly from IVR therapies, for instance, to circumvent issues in understanding relevant concepts and interrelations. In this context, immersing the user into a virtual body (ie, avatar) appears promising for enhancing learning (eg, by changing perspectives) and usability (eg, natural interactions). However, design requirements, immersion procedures, and proof of concept of such embodiment illusion (ie, substituting the real body with a virtual one) have not been explored in this group. OBJECTIVE Our study aimed to establish design guidelines for IVR embodiment illusions in people with MBID. We explored 3 factors to induce the illusion, by testing the avatar's appearance, locomotion using IVR controllers, and virtual object manipulation. Furthermore, we report on the feasibility to induce the embodiment illusion and provide procedural guidance. METHODS We conducted a user-centered study with 29 end users in care facilities, to investigate the avatar's appearance, controller-based locomotion (ie, teleport, joystick, or hybrid), and object manipulation. Overall, 3 iterations were conducted using semistructured interviews to explore design factors to induce embodiment illusions in our group. To further understand the influence of interactions on the illusion, we measured the sense of embodiment (SoE) during 5 interaction tasks. RESULTS IVR embodiment illusions can be induced in adults with MBID. To induce the illusion, having a high degree of control over the body outweighed avatar customization, despite the participants' desire to replicate their own body image. Similarly, the highest SoE was measured during object manipulation tasks, which required a combination of (virtual) locomotion and object manipulation behavior. Notably, interactions that are implausible (eg, teleport and occlusions when grabbing) showed a negative influence on SoE. In contrast, implementing artificial interaction aids into the IVR avatar's hands (ie, for user interfaces) did not diminish the illusion, presuming that the control was unimpaired. Nonetheless, embodiment illusions showed a tedious and complex need for (control) habituation (eg, motion sickness), possibly hindering uptake in practice. CONCLUSIONS Balancing the embodiment immersion by focusing on interaction habituation (eg, controller-based locomotion) and lowering customization effort seems crucial to achieve both high SoE and usability for people with MBID. Hence, future studies should investigate the requirements for natural IVR avatar interactions by using multisensory integrations for the virtual body (eg, animations, physics-based collision, and touch) and other interaction techniques (eg, hand tracking and redirected walking). In addition, procedures and use for learning should be explored for tailored mental health therapies in people with MBID.
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Affiliation(s)
| | | | - Joanne VanDerNagel
- Department of Human Media Interaction, University of Twente, Enschede, Netherlands.,Centre for Addiction and Intellectual Disability, Tactus Addiction Care, Enschede, Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, Netherlands
| | - Dirk Heylen
- Department of Human Media Interaction, University of Twente, Enschede, Netherlands
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Arissen C, van der Helm L, Dijkstra B, Markus W. Virtual Reality to Support Inpatient Addiction Treatment: Patients Are Ready, What About Therapists? A Feasibility Study. Int J Ment Health Addict 2022; 21:1-23. [PMID: 35915855 PMCID: PMC9330849 DOI: 10.1007/s11469-022-00843-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 11/01/2022] Open
Abstract
This study aimed to identify facilitators and barriers for implementation of virtual reality therapy (VRT), used to train communication and problem-solving skills aiding relapse prevention, when integrated with addiction treatment (Treatment as Usual; TAU). Mixed methods were used in an observational, partly prospective, design. A total of 21 therapists and 113 patients from three inpatient addiction clinics were assessed. Therapists filled in questionnaires to gauge expectancies and experiences regarding facilitators and barriers at baseline, after a try-out period, halfway, and at the end of the pilot lasting 6-12 months. They also participated in focus-group interviews. Patients filled in similar questionnaires before an initial, and after they finished a third, VRT session. In addition, nine patients were interviewed. All VRT sessions were logged, with patients answering additional questions. Acceptability of VRT was high in both groups. It was feasible to integrate VRT with TAU and integration showed potential effectiveness. Barriers included incidental motion sickness, technical difficulties, costs, and device setup time. Both therapists and patients advocated VRT use to augment addiction treatment. Findings suggest a clinical effectiveness study is warranted.
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Affiliation(s)
- Clemence Arissen
- IrisZorg: Institution for Addiction Care, Sheltered Housing and Social Support Services, P.O. box 351, 6800 AJ Arnhem, The Netherlands
| | - Laura van der Helm
- IrisZorg: Institution for Addiction Care, Sheltered Housing and Social Support Services, P.O. box 351, 6800 AJ Arnhem, The Netherlands
- NISPA: Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, P.O. box 9104, 6500 HE Nijmegen, The Netherlands
| | - Boukje Dijkstra
- NISPA: Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, P.O. box 9104, 6500 HE Nijmegen, The Netherlands
| | - Wiebren Markus
- IrisZorg: Institution for Addiction Care, Sheltered Housing and Social Support Services, P.O. box 351, 6800 AJ Arnhem, The Netherlands
- NISPA: Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, P.O. box 9104, 6500 HE Nijmegen, The Netherlands
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