Virtual reality-assisted cognitive behavioral therapy for patients with alcohol use disorder: a randomized feasibility study

Abstract

Introduction: Cognitive behavioral therapy (CBT) is an evidence-based treatment for alcohol use disorder (AUD). Exposure to high-risk situations in virtual reality (VR) has been suggested to have a potential therapeutical benefit, but no previous study has combined VR and CBT for AUD. We aimed to investigate the feasibility of using VR-simulated high-risk environments in CBT-based treatment of AUD.

Methods: We randomized ten treatment-seeking AUD-diagnosed individuals to three sessions of conventional CBT or VR-assisted CBT performed at two outpatient clinics in Denmark. In each session, patients randomized to VR-CBT were exposed to VR-simulations from a restaurant to induce authentic thoughts, emotions, physiological reactions, and craving for CBT purposes. The primary outcome measure was feasibility: Drop-out rate, psychological reactions, and simulator sickness. Secondary outcomes were assessment of preliminary short-term changes in alcohol consumption and craving from baseline to one-week and one-month follow-up. In addition, the study was conducted for training in operationalization of VR equipment, treatment manuals, and research questionnaires.

Results: The majority of patients completed all study visits (90%). VR induced authentic high-risk related thoughts, emotions, and physiological reactions that were considered relevant for CBT by patients and therapists. Four of five patients randomized to VR-CBT experienced cravings during VR simulations, and most of these patients (3/5) experienced mild simulator sickness during VR exposure. The preliminary data showed that patients receiving VR-CBT had more reduction in alcohol consumption than patients receiving conventional CBT at one week- (median 94% vs. 72%) and one-month follow-up (median 98% vs. 55%). Similar results were found regarding changes in cravings.

Conclusion: We demonstrated VR-CBT to be a feasible intervention for patients with AUD which supports continued investigations in a larger randomized clinical trial evaluating the efficacy of VR-CBT.

Clinical trial registration: https://www.clinicaltrials.gov/study/NCT04990765?cond=addiction%20CRAVR&rank=2, identifier NCT05042180.

Keywords: addiction; alcohol; cognitive behavioral therapy; feasibility; innovation; psychotherapy; technology; virtual reality.

Figure 1

Study flow chart.

Figure 2

Interventions. The figure shows the main difference between the two study arms. (A) illustrated a fundamental element of CBT, the cognitive analysis, whereas (B) illustrates a patient exposed to a high-risk situation which induces craving (emojis). During exposure, the therapist then asks the patient what goes through his mind for cognitive analysis, either performed during VR exposure (C) or after exposure, as illustrated in (A). Finally, the nurse instructs the patient to practice a new coping strategy (D).

Figure 3

VR high-risk restaurant scenes. The figure shows the six different restaurant scenes used for VR exposure. (A) Arrival at a restaurant (1:39 mins), (B) Ordering food and drinks (3:53 mins), (C) Drinks are being served (3:23 mins), (D) Drinking problem is revealed (3:55 mins), (E) Friend offers shots (3:52 mins), (F) Friends want to go out (2:13 mins). Scenes (A, C, E) were used for cognitive analysis, while scenes (B, D, F) were used for coping skill training.

Figure 4

Craving before, during and after each VR exposure. The figure shows craving levels before, during, and after all six different VR restaurant scenes for each patient randomized to VR-CBT (ID1, ID3, ID6, ID7, and ID9). (A) Arrival at restaurant, (B) Ordering food and drinks, (C) Drinks are being served, (D) Drinking problem is revealed, (E) Friend offers shots, (F) Friends want to go out. The graphs correspond to the videos in Figure 3 . Scenes (A, C, E) were used for cognitive analysis, while scenes (B, D, F) were used for coping skill training.

Figure 5

Alcohol consumption.