Attentional Bias, Alcohol Craving, and Anxiety Implications of the Virtual Reality Cue-Exposure Therapy in Severe Alcohol Use Disorder: A Case Report

Abstract

Aims: Attentional bias (AB), alcohol craving, and anxiety have important implications in the development and maintenance of alcohol use disorder (AUD). The current study aims to test the effectiveness of a Virtual Reality Cue-Exposure Therapy (VR-CET) to reduce levels of alcohol craving and anxiety and prompt changes in AB toward alcohol content.Method: A 49-year-old male participated in this study, diagnosed with severe AUD, who also used tobacco and illicit substances on an occasional basis and who made several failed attempts to cease substance misuse. The protocol consisted of six VR-CET booster sessions and two assessment sessions (pre- and post-VR-CET) over the course of 5 weeks. The VR-CET program consisted of booster therapy sessions based on virtual reality (VR) exposure to preferred alcohol-related cues and contexts. The initial and final assessment sessions were focused on exploring AB, alcohol craving, and anxiety using paper-and-pencil instruments and the eye-tracking (ET) and VR technologies at different time points.Results: Pre and post assessment sessions indicated falls on the scores of all instruments assessing alcohol craving, anxiety, and AB.Conclusions: This case report, part of a larger project, demonstrates the effectiveness of the VR-CET booster sessions in AUD. In the post-treatment measurements, a variety of instruments showed a change in the AB pattern and an improvement in craving and anxiety responses. As a result of the systematic desensitization, virtual exposure gradually reduced the responses to significant alcohol-related cues and contexts. The implications for AB, anxiety and craving are discussed.

Virtual reality: a powerful technology to provide novel insight into treatment mechanisms of addiction

“…Notably, the study results also indicate that VR cue exposure therapy might be more efficacious in patients with higher than in those exhibiting lower levels of craving. The effectiveness of VR cue-exposure therapy has also been shown in a case report [ 32 ]. Taken together, alcohol craving is elicited in cue-laden VR environments; the effects differ between patients with AUD and social drinkers, depending on the social context, and are affected by cross-cue reactivity.…”

“…Cue exposure induces anxiety in patients with AUD, whereas it decreases anxiety in social drinkers, and these cue-elicited anxiety effects differentiate better between patients and social drinkers than cue-elicited craving levels [ 27 ]. In a case report of a male patient with long lasting severe AUD, six cue-exposure sessions reduced cue-elicited anxiety levels by 95% [ 32 ].…”

“…In patients with AUD, addiction-related cues in VR attract more attention to the sight, the smell, and the thoughts about alcohol than neutral cues [ 26 ]. In a male patient with severe AUD, six VR cue exposure sessions reduced interference towards alcohol content in the Alcohol Stroop Task [ 32 ]. A treatment study applying cognitive behavioral therapy in a VR setting to tobacco smokers showed higher attention to visual and olfactory cigarette cues and increased thoughts about smoking in cue-enriched conditions than in a neutral condition [ 40 ].…”

“…Due to the computer-controlled presentation of stimuli and timing, VR technology enables higher standardization than human-operated experimental paradigms. VR cue exposure-induced changes of cue-reactivity (craving and anxiety) also generalize into daily life experiences, which is a very important goal when aiming at tailoring effective treatment strategies [ 32 ].…”

Assessing attentional bias for alcohol-related cues using eye tracking in a virtual reality environment

“…Several studies showed that it is possible to elicit craving for various addictive substances after immersion in a VR environment (for a review, see Pericot-Valverde et al, 2016;Bordnick and Washburn, 2019;Segawa et al, 2020). So far, only a few studies have used VR to induce craving together with an independent assessment of attentional biases with an eyetracking technique, but attentional biases were measured outside of the VR environment (Choi and Lee, 2015;Ghiţă et al, 2021).…”