Behavioral, craving, and anxiety responses among light and heavy drinking college students in alcohol-related virtual environments

Drinking-related behavior in college students represents a public concern with consequences for health and academic performance. The aim of the present study was to determine which measures (behavioral and self-reported measures of craving and anxiety) differentiate best between light- and heavy-drinking college students when exposed to a virtual reality (VR) alcohol-cue environment. 25 college students participated in this study, of whom 13 were light drinkers (standard drink units (SDU)/month ≤ 10) and 12 heavy drinkers (SDU)/month ≥ 11). Participants completed the Alcohol Use Disorder Identification Test (AUDIT) before exposure to the VR environment. Heavy drinkers scored higher than light drinkers on AUDIT. The virtual environment consisted of four situations: restaurant, bar, chill-out area, and bedroom, where participants could choose alcoholic or non-alcoholic beverages. An Oculus Rift DK2 headset was used as the HMD. In each situation, craving and anxiety were self-reported on a visual analog scale (VAS, from 0 to 10). The results showed differences between groups in the type of beverage chosen in the VR situations, whereby heavy drinkers chose alcoholic drinks more frequently. However, no statistically significant differences were found between groups in craving or anxiety levels reported on the VAS during VR exposure. Heavy-drinking students show a preference for alcoholic beverages in all VR situations compared with light drinkers, but do not experience different levels of craving or anxiety as assessed with VAS. If virtual environments are used to detect heavy drinking cases, behavioral parameters such as choosing between alcoholic or non-alcoholic cues seem more suitable than self-reports of craving or anxiety. Nevertheless, future studies are necessary to determine whether more objective measures of craving and anxiety (eye tracking or psychophysiological responses) perform better than selfreports in differentiating between heavy and light drinking

The influence of gender and body dissatisfaction on body‐related attentional bias: An eye‐tracking and virtual reality study

Objective In the attentional bias (AB) phenomenon, eating disorder (ED) patients show a tendency to pay more attention to self‐attributed unattractive body parts than to other body parts. However, little research has focused on gender differences in body‐related attention, controlling for body dissatisfaction (BD). This study aimed to assess gender differences in AB toward specific weight‐ or nonweight‐related body parts using a virtual reality (VR)‐based embodiment technique and an eye‐tracking AB assessment. Method Forty‐five women (23 with high BD and 22 with low BD) and 40 men (20 with high BD and 20 with low BD) were subsequently embodied in three virtual avatars, the first based on the participant's actual measurements, the second being larger than the participant, and the third being the same as the first avatar. The number of fixations and complete fixation time on weight‐related areas of interest (W‐AOIs) and nonweight‐related areas of interest (NW‐AOIs) were recorded for the three assessment time/avatars. Results The results showed a statistically significant interaction between gender and time for total fixation time and number of fixations (p < .05). BD levels did not significantly affect the results. Overall, women paid more attention to the W‐AOIs than men, who in turn paid more attention to the NW‐AOIs. Furthermore, preliminary evidence was found for an AB toward muscular‐related AOIs among men. Conclusions This study provides new information about gender differences and BD in gaze pattern behaviors. Future psychological ED assessments and treatments could take advantage of the possibilities of VR while real‐time AB is objectively measured

Determinants of cue-elicited alcohol craving and perceived realism in Virtual Reality environments among patients with alcohol use disorder

The identification of variables that can modulate the efficacy of cue exposure using virtual reality (VR) is crucial. This study aimed to explore determinant variables of cue-elicited alcohol craving and perceived realism (PR) of environments and alcoholic beverages during a VR cue-exposure session among alcohol use disorder (AUD) outpatients. A prospective cohort study was conducted amongst 72 outpatients with AUD from a clinical setting. Alcohol craving experienced during VR exposure and PR of virtual environments and alcoholic drinks were evaluated after a VR session of exposure to alcohol-related contexts and cues. Sociodemographic, psychological and consumption characteristics were examined as possible predicting variables. Multiple linear regression analyses showed that the AUD severity and PR of beverages were predictors of cue-elicited alcohol craving. Educational level, PR of beverages and age were predictors of the PR of VR environments. In relation to the PR of VR beverages, cue-elicited alcohol craving and the PR of environments were predictors. A simple mediational model was also performed to analyze the influence of the PR of beverages on the relationship between the AUD severity and alcohol craving experienced during VR exposure: an indirect or mediational effect was found. PR of alcoholic beverages was (1) a key predictor of the PR of VR environments (and vice versa) and the alcohol craving (and vice versa) experienced during VR cue-exposure sessions using ALCO-VR software among AUD patients and (2) a mediator between AUD severity and cue-elicited alcohol craving

Identifying Triggers of Alcohol Craving to Develop Effective Virtual Environments for Cue Exposure Therapy

Background: Many studies have indicated that alcohol craving is a core mechanism in the acquisition, maintenance, and precipitation of relapse in alcohol use disorder (AUD). A common treatment approach in AUD is cue exposure therapy (CET). New technologies like virtual reality (VR) have the potential to enhance the effectiveness of CET by creating realistic scenarios in naturalistic environments. In this study, we aimed to determine relevant triggers of alcohol craving in patients with AUD. Methods: We enrolled 75 outpatients diagnosed with AUD according to the DSM-5 criteria Participants completed the Alcohol Use Disorder Identification Test and a self-administered questionnaire to assess alcohol craving. The variables included in the craving questionnaire were as follows: presence of others, situations, time of the day, day of the week, mood, and type of alcoholic beverage. Results: Greater levels of alcohol craving were seen in many situations, including being at a party, in a restaurant, in a bar or pub, and at home. Drinking alone and drinking with two or more friends were equally associated with higher levels of craving. Drinking at night and drinking at weekends also emerged as triggers for alcohol craving. Emotional states like anxiety or tension, sadness, stress, frustration, or irritability were highly associated with urges to drink alcohol. The alcoholic drinks most highly associated with increased levels of craving were beer, wine, and whisky. Gender and age implications were discussed. Conclusion: This study is part of a larger project aiming to develop and validate CET based on VR technology for patients with AUD who are resistant to classical treatment. The identified triggers have been used to develop relevant VR environments for CET, and further research is ongoing to implement our findings

Craving and Anxiety Responses as Indicators of the Efficacy of Virtual Reality-Cue Exposure Therapy in Patients Diagnosed with Alcohol use Disorder

Introduction: Virtual Reality (VR) technology has shown promising results as an assessment and treatment instrument in substance use disorders, particularly in attempts to reduce craving. A common application of the VR technology in treatment is based on cue-exposure therapy (CET). Following from previous results, the present case series is part of a larger project aiming to test the efficacy of the Virtual Reality-Cue Exposure Therapy (VR-CET) versus Cognitive-Behavioral Therapy (CBT). Method: Eight patients between ages 40 and 55 (Mage = 49, SD = 5.54) from the Addictive Behaviors Unit at the Hospital Clinic of Barcelona participated in this study after providing written informed consent. Patients were randomly assigned to the VR-CET group (three patients) or the CBT group (five patients). The protocol of the clinical trial consisted of a pre-treatment session (the initial assessment session), six sessions of CBT or VR-CET, and a post-treatment session (post-assessment session). The VR-CET sessions consisted of exposure to alcohol-related cues and environments aiming to reduce anxiety and craving responses to alcohol-related stimuli. The CBT sessions consisted of classical standardized therapy for the treatment of addictions, as previously applied in other clinical trials. In the pre- and post-treatment sessions, patients completed several measures of alcohol craving and anxiety and visual analog scales (VAS) during VR exposure. Results: Our data indicated a significant reduction in both groups in all scores of craving and anxiety responses, as assessed by the different instruments. In addition, the VR-CET group obtained lower scores on anxiety and craving responses than the CBT group. Conclusions: In this ongoing project, the first phase of the clinical trial showed significant improvements in terms of craving and anxiety reduction in both groups, emphasizing that VR-CET can be as efficient as CBT. In addition, patients in the VR-CET group obtained slightly better scores than patients in the CBT group, suggesting the clinical potential of the VR technology in the treatment of substance use disorders. We propose that VR-based CET can be a useful complement to existing treatment methods for AUD patients

Attentional bias, alcohol craving, and anxiety implications of the virtual reality cue-exposure therapy in severe alcohol use disorder: a case report

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

Attentional bias assessment in patients with alcohol use disorder: an eye-tracking study

Introduction: Alcohol use disorder (AUD) represents a major general health concern with important consequences for individuals' psycho-social functioning. Many studies suggest that cognitive processes such as attentional bias (AB) are heavily involved in the phases of acquisition, maintenance and relapse precipitation in AUD. AB is described as an implicit selective attention when processing visual information in favor of desired cues, which may elicit craving for alcohol and facilitate drinking-related behaviors. In line with recent studies of the applications of human-computer interaction in the field of psychology, the current study aimed to assess attentional bias towards alcohol-related images using eye-tracking technology. Specifically, we explored the first gaze towards alcohol-related images versus neutral images in patients with short-term and long-term abstinence. Method: 24 outpatients (Mage = 53, SD = 11.65) from the Addictive Behavior Unit of the Hospital Clinic of Barcelona participated in the study. The inclusion criteria were diagnoses of AUD and normal or corrected-to-normal visual acuity. Participants were divided according to their abstinence period, with the cut-off point being set at four months. Fourteen patients had been abstinent for less than four months (M = 1, SD = 0.96), and 10 for longer than this period (M = 14, SD = 8.17). The self-reported abstinence period was supported by the results of urine analyses performed in all patients. Participants completed the Alcohol Use Disorder Identification Test (M = 19.75, SD = 9.34) and the Visual Attention Task (VAT). The VAT consisted of images related to alcohol consumption versus neutral images such as office objects. The EyeTribe eye-tracking technology was used to record eye movement activity during the VAT. Results: Our data indicated a statistically significant difference between patients with short-term and long-term abstinence regarding their first fixation towards alcohol-related and neutral images. Patients abstinent for less than four months had a tendency to look first at images related to alcohol consumption, whereas patients abstinent for more than four months were more likely to look first at neutral images, regardless of their AUDIT score. Conclusions: Patients with short-term abstinence had a greater AB than patients with long-term abstinence. The first gaze seems to be a sensitive parameter for differentiating between patients with low and high AB. The use of eye-tracking technology suggests that AB is important in clinical assessment and should be addressed in treatment as well as in relapse prevention. We consider that the eye- tracking technology is a promising instrument for assessing current addictive behavior

Predictors of Changes in alcohol craving levels during a virtual reality cue exposure treatment among patients with alcohol use disorder

Background/Objective: Determining the predictive variables associated with levels of alcohol craving can ease the identification of patients who can benefit from treatments. This study aimed to describe changes (improvement or no change/deterioration) in alcohol craving levels and explore the predictors of these changes from admission to discharge in outpatients with alcohol use disorder (AUD) undergoing treatment-as-usual (TAU), or treatment-as-usual supplemented with virtual reality cue-exposure therapy (TAU + VR-CET). Method: A prospective cohort study was conducted amongst 42 outpatients with AUD (n = 15 TAU + VR-CET and n = 27 TAU) from a clinical setting. Changes in the levels of alcohol craving between admission and discharge were assessed with the Multidimensional Alcohol Craving Scale. Sociodemographic characteristics (age, gender, education, and socioeconomic and civil status), cognitive-a ective behavioral patterns (AUD severity, abstinence duration, psychiatric comorbidity, state anxiety, attentional bias, and substance use), and type of treatment (TAU + VR-CET and only TAU) were also evaluated. Results: The TAU + VR-CET group showed greater changes of improvement in the levels of alcohol craving than the TAU group ( 2 = 10.996; p = 0.001). Intragroup changes in alcohol craving from pre to post-treatment were significant in the TAU + VR-CET group ( 2 = 13.818; p = 0.003) but not within the TAU group ( 2 = 2.349; p = 0.503). The odds of an improvement in any of the craving levels between pre- and post-test was 18.18 (1/0.055) times higher in the TAU + VR-CET group with respect to the TAU group. The use of illicit drugs in the month prior to the test increased the odds of having a positive change by 18.18 (1/0.055) with respect to not having consumed. Conclusions: Including VR-CET in TAU programs may provide benefits in the treatment of AUDs mainly among patients with intense alcohol craving and individuals having used illicit substances prior to treatment