A randomized controlled trial of a virtual reality based, approach-avoidance training program for alcohol use disorder: a study protocol

Mellentin, Angelina Isabella; Nielsen, Anette Søgaard; Ascone, Leonie; Wirtz, Janina; Samochowiec, Jerzy; Kucharska-Mazur, Jolanta; Schadow, Friedrich; Lebiecka, Zofia; Skoneczny, Tomasz; Mistarz, Nicolai; Bremer, Thomas; Kühn, Simone

doi:10.1186/s12888-020-02739-1

Cited by 13 publications

(10 citation statements)

References 79 publications

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“…To evaluate the (cost-)effectiveness, relevant RCTs (level VR3), including adequate follow-up periods, need to be conducted. During our literature review, we identified five study protocols that report on planned RCTs and insights into potential new treatment mechanisms [77][78][79][80][81]. The studies focus on approach-avoidance training, mindfulness-based relapse prevention, memory-retrieval extinction and the use of pharmacotherapy (Isradipine) to enhance the effect of VRET on the extinction of craving.…”

Section: Future Outlookmentioning

confidence: 99%

Clinical Relevance of Immersive Virtual Reality in the Assessment and Treatment of Addictive Disorders: A Systematic Review and Future Perspective

Langener

VanDerNagel

Manen

et al. 2021

JCM

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(1) Background: Virtual reality (VR) has been investigated in a variety of psychiatric disorders, including addictive disorders (ADs); (2) Objective: This systematic review evaluates the current evidence of immersive VR (using head-mounted displays) in the clinical assessment and treatment of ADs; (3) Method: PubMed and PsycINFO were queried for publications up to November 2020; (4) Results: We screened 4519 titles, 114 abstracts and 85 full-texts, and analyzed 36 articles regarding the clinical assessment (i.e., diagnostic and prognostic value; n = 19) and treatment (i.e., interventions; n = 17) of ADs. Though most VR assessment studies (n = 15/19) showed associations between VR-induced cue-reactivity and clinical parameters, only two studies specified diagnostic value. VR treatment studies based on exposure therapy showed no or negative effects. However, other VR interventions like embodied and aversive learning paradigms demonstrated positive findings. The overall study quality was rather poor; (5) Conclusion: Though VR in ADs provides ecologically valid environments to induce cue-reactivity and provide new treatment paradigms, the added clinical value in assessment and therapy remains to be elucidated before VR can be applied in clinical care. Therefore, future work should investigate VR efficacy in randomized clinical trials using well-defined clinical endpoints.

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Section: Future Outlookmentioning

confidence: 99%

Clinical Relevance of Immersive Virtual Reality in the Assessment and Treatment of Addictive Disorders: A Systematic Review and Future Perspective

Langener

VanDerNagel

Manen

et al. 2021

JCM

View full text Add to dashboard Cite

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“…If this study demonstrates that AACTP is effective in patients with AUD, other means of assessing ABs and delivering cognitive training programs could be implemented by utilizing technologies such as virtual reality (VR) and augmented reality [AR; (89)]. These technologies have already been developed for targeting approach biases through the approach avoidance training program (90). Paradigms using VR and AR might overcome some of the shortcomings of the AACTP by increasing its ecological validity.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial of Attentional Control Training for Treating Alcohol Use Disorder

et al. 2021

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Background: There is consistent evidence that community and clinical samples of individuals with an alcohol use disorder (AUD) have attentional biases toward alcohol cues. The alcohol attentional control training program (AACTP) has shown promise for retraining these biases and decreasing alcohol consumption in community samples of excessive drinkers. However, there is a lack of evidence regarding the effectiveness of ACTP in clinical AUD samples. The main aim of the present study is to investigate whether primary pharmacological and psychological, evidence-based alcohol treatment can be enhanced by the addition of a gamified AACTP smartphone application for patients with an AUD.Design and Methods: The study will be implemented as a randomized controlled trial. A total of 317 consecutively enrolled patients with AUD will be recruited from alcohol outpatient clinics in Denmark. Patients will be randomized to one of three groups upon initiation of primary alcohol treatment: Group A: a gamified AACTP smartphone application + treatment as usual (TAU); Group B: a gamified AACTP sham-control application + TAU; or Group C: only TAU. Treatment outcomes will be assessed at baseline, post-treatment, and at 3- and 6-month follow-ups. Repeated measures MANOVA will be used to compare the trajectories of the groups over time on alcohol attentional bias, alcohol craving, and drinking reductions. It is hypothesized that Group A will achieve better treatment outcomes than either Group B or Group C.Perspectives: Because attentional bias for alcohol cues is proportional to the amount of alcohol consumed, and these biases are not addressed within current evidence-based treatment programs, this study is expected to provide new evidence regarding the effectiveness of the gamified AACTP in a clinical population. Furthermore, due to promising results found using AACTP in community samples of excessive drinkers, there is a high probability that the AACTP treatment in this study will also be effective, thereby allowing AACTP to be readily implemented in clinical settings. Finally, we expect that this study will increase the effectiveness of evidence-based AUD treatment and introduce a new, low-cost gamified treatment targeting patients with an AUD. Overall, this study is likely to have an impact at the scientific, clinical, and societal levels.Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT05102942?term=NCT05102942&draw=2&rank=1, identifier: NCT05102942.

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“…Most recently, Mellentin et al published a study protocol of a randomized controlled trial to examine the effectiveness of a stimuli-relevant approach-avoidance training programme (AATP) delivered in a VR environment compared to AATP without VR as well as in comparison to treatment as usual (TAU) in a large sample (estimated n = 204) of alcohol use disorder (AUD) patients [43]. The author hypothesized that AATP is more effective than TAU and VR AATP more effective than standard AATP.…”

Section: Vr-based Therapeutic Approachesmentioning

confidence: 99%

Virtual Reality-Based Treatment Approaches in the Field of Substance Use Disorders

et al. 2021

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Purpose Substance use disorders (SUD) are burdening chronic conditions characterized by high relapse rates despite severe negative consequences. Substance-related cues that elicit craving by means of automatic physiological and behavioural responses have long been suggested to predict relapse. One major mechanism contributing to relapse behaviour are cue-induced behavioural approach tendencies towards the addictive agent. Recently, there has been an emerging interest in virtual reality (VR)-based approaches to assess and modify craving and its related responses. This review aims at elucidating (1) VR techniques applied in the field of SUD, (2) VR as an induction/assessment tool for biopsychological correlates of craving and (3) VR-based therapeutic approaches. Findings There is an emerging number of studies focusing on different substances of abuse incorporating VR in craving induction/assessment as well as therapy. Despite some limitations as missing of randomized controlled clinical trials with large samples and missing data on the long-term effects of VR treatment, the VR approach showed consistent results in eliciting and reducing craving across different substances. Summary This review suggests virtual reality as a promising tool for the assessment and treatment of craving among individuals with substance use disorders. Because of its ecological validity, VR unifies the benefits of a laboratory setting with the advantages of a realistic environment. Further studies with large samples and randomized controlled clinical trials using more homogenous VR techniques as well as assessment of objective biophysiological craving markers are required.

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A randomized controlled trial of a virtual reality based, approach-avoidance training program for alcohol use disorder: a study protocol

Cited by 13 publications

References 79 publications

Clinical Relevance of Immersive Virtual Reality in the Assessment and Treatment of Addictive Disorders: A Systematic Review and Future Perspective

Clinical Relevance of Immersive Virtual Reality in the Assessment and Treatment of Addictive Disorders: A Systematic Review and Future Perspective

A Randomized Controlled Trial of Attentional Control Training for Treating Alcohol Use Disorder

Virtual Reality-Based Treatment Approaches in the Field of Substance Use Disorders

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