The Effects of Training to Reduce Automatic Action Tendencies Toward Alcohol Using the Virtual Alcohol Approach-Avoidance Task in Heavy Social Drinkers

Abstract

This study aimed to reduce the approach tendency toward alcohol among heavy social drinkers using the Virtual Alcohol Approach-Avoidance Training Task training. A total of 28 heavy social drinkers were randomly assigned to either the training group (n = 14) or the control group (n = 14). The training group was implicitly trained to avoid situations that involved drinking alcohol and to approach situations that involved drinking nonalcoholic beverages. On the other hand, the control group received a sham training condition with the same ratio of approach or avoidance of drinking either alcohol or a nonalcoholic beverage. All participants made three visits in a period of 2-3 weeks to participate in either the training or sham training. As a result, the training group showed a decrease in implicit approach tendencies toward alcohol, but not in explicit craving for alcohol. In contrast, the control group showed an increase in both implicit approach tendencies and explicit craving toward alcohol. These results indicate that the virtual reality training to avoid alcohol-related stimuli or environments might reduce automatic action tendencies toward alcohol, while simply being exposed to alcohol-related stimuli or environments might increase craving for alcohol in the sham training group. Our findings also suggest that, including not only visual stimuli but also auditory stimuli in a virtual environment might be a tool for changing approach bias.

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

“…Therefore, a systematic quality appraisal with standardized clinical frameworks or meta-analysis of data was not possible [73,74]. Another issue is that we excluded two papers from the review because it was unclear whether HMDs were used, because of a lack of detailed methodological reporting [75,76]. These methodological shortcomings need to be addressed to further the VR field and bring VR technology to clinical care for patients with ADs.…”

The Effects of Virtual Reality in Targeting Transdiagnostic Factors for Mental Health: A Systematic Review of the Literature

“…The number of studies taken into consideration for each transdiagnostic factor varied. Avoidance was the most studied transdiagnostic factor found in 23 articles (63.89%) ( n = 19 experimental studies and n = 4 case studies) [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ], followed by emotion regulation, which was found in eight articles (22.22%; n = 7 experimental studies and n = 1 case study) [ 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ]; aggression, which was found in three experimental studies (8.33%) [ 70 , 71 , 72 ]; impulsivity, which was found in two studies (5.56%; n =1 experimental study and n = 1 case study) [ 71 , 73 ]; and cognitive reappraisal, which was found in two studies (5.56%; n = 1 experimental study and n = 1 case study) [ 63 , 74 ]. No studies were found for the transdiagnostic factor of disinhibition.…”

“…Regarding comparisons between VRET and in-vivo exposure, VRET was more effective than the latter in reducing social avoidance in SAD patients and more practical according to therapists in one study [40], but less effective in another [46]. Finally, fewer but promising results were found for the ability of VR-based treatment to improve other types of avoidance, such as agoraphobic avoidance in patients with psychosis [43] or panic disorder with agoraphobia [53], cognitive avoidance in city violence crime victims with PTSD or acute stress disorder [40], alcohol-approach avoidance in patients with substance-use disorder [48], and food avoidance in a patient with bulimia nervosa [57] (see Table S1 for additional details of each study).…”

Is Virtual Reality Cue Exposure a Promising Adjunctive Treatment for Alcohol Use Disorder?

“…Virtual technology may also contribute to the prognostication of future beverage choices (alcoholic vs. non-alcoholic) [70]. There are also reports that VR-CET-based training may lead to changing approach bias via visual and auditory stimuli, thus reducing automatic action tendencies toward alcohol [26]. Elsewhere, a similar task was reported to be a useful and accurate measure of craving in social drinkers, mostly due to its ability to provide realistic scenarios and the sense of immersion in virtual environments [71].…”

“…The majority of the available evidence demonstrates the virtual environment's great capacity to induce cravings, amongst others, for alcohol [14], cocaine [15], or nicotine [16][17][18]. Therefore, there are reports of VR applications in the treatment of a range of addictive disorders, including nicotine and alcohol dependence, gambling, or Internet gaming disorders [7,19], with interventions based on cue exposure for smoking [20][21][22] and methamphetamine addiction [23][24][25], or approach and avoidance training for alcohol dependence [6,26]. Nevertheless, studies to date concerning the most widely researched nicotine dependence seem to yield somewhat conflicting results, suggesting a comparable effect of virtual reality cue exposure therapy (VR-CET) to conventional cognitive-behavioral therapy (CBT) interventions [27], greater efficaciousness of CBT-adjuvant VR-CET [20], or no increase in efficacy in response to add-on VR-CET protocol combined with an elevated relapse risk elsewhere [22].…”