Cue reactivity to drug-related stimuli is a frequently observed phenomenon in drug addiction. Cue reactivity refers to a classical conditioned response pattern that occurs when an addicted subject is exposed to drug-related stimuli. This response consists of physiological and cognitive reactions. Craving, a subjective desire to use the drug of choice, is believed to play an important role in the occurrence of relapse in the natural setting. Besides craving, other subjective cue-elicited reactions have been reported, including withdrawal symptoms, drug-agonistic effects, and mood swings. Physiological reactions that have been investigated include skin conductance, heart rate, salivation, and body temperature. Conditioned reactivity to cues is an important factor in addiction to alcohol, nicotine, opiates, and cocaine. Cue exposure treatment (CET) refers to a manualized, repeated exposure to drug-related cues, aimed at the reduction of cue reactivity by extinction. In CET, different stimuli are presented, for example, slides, video tapes, pictures, or paraphernalia in nonrealistic, experimental settings. Most often assessments consist in subjective ratings by craving scales. Our pilot study will show that immersive virtual reality (IVR) is as good or even better in eliciting subjective and physiological craving symptoms as classical devices.

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Fully immersive and stereoscopic Virtual Environments (VE) represent a powerful multimedia tool for laboratory-based simulations of distinct scenarios including scenarios for evaluating stressful situations resembling reality. Thus far, cortisol secretion as a neuroendocrine parameter of stress has not been evaluated within a Virtual Reality (VR)-based paradigm. In this study 94 healthy volunteers were subjected to a provocative VR-paradigm and a cognitive stress task. Provocative in this context means the VE was designed to provoke physiological reactions (cortisol secretion) within the respective users by purpose. It was tested (a) if a fully dynamic VE as opposed to a static VE can be regarded as a stressor and (b) if such a fully dynamic VE can modify an additional response to a cognitive stressor presented within the VE additionally. Furthermore, possible gender-related impacts on cortisol responses were assessed. A significant cortisol increase was observed only after the combined application of the fully dynamic VE and the cognitive stressor, but not after application of the dynamic VE or the cognitive stressor alone. Cortisol reactivity was greater for men than for women. We conclude that a fully dynamic VE does not affect cortisol secretion per se, but increases cortisol responses to a dual task paradigm that includes performance of a stressful mental task. This provides the basis for the application of VR-based technologies in neuroscientific research, including the assessment of the human Hypothalamus-Pituitary-Adrenal (HPA) axis regulation.

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