JMIR Publications

ABSTRACT

Background:

Craving is a diagnostic criterion and predictor for relapse in patients with alcohol dependence (AD) and is induced in Cue Exposure Therapy (CET) to prepare patients for real-life risk situations. The benefits of Virtual Reality cue exposure (VR-CE) include increased practicability, standardization and personaliziation of CET. Despite being relevant for diagnostics and therapy, psychophysiological reaction to alcohol cues and its relationship to subjective craving is not sufficiently examined.

Objective:

We aim to investigate the induction of subjective and physiological craving and their relationship in patients with AD during an innovative VR-CE paradigm including two alcohol-associated risk scenarios and a neutral baseline scenario.

Methods:

Craving is analyzed by measuring physiological reactions (electrodermal activity (EDA, including non-specific skin conductance responses (NS.SCR) and skin conductance level (SCL)), heart rate (variability) (HR(V)), brightness corrected pupil diameter (BCPD), respiration rate (RR)) and subjective craving in 61 patients with AD. Linear mixed-effects models are conducted to estimate the effects of the VR-CE. Correlations between subjective and physiological craving parameters are analyzed using Spearman correlations.

Results:

Results show that alcohol-associated VR-scenarios have significant effects on subjective craving (moderate effect sizes between d=0.56 and d=0.72 ) and on NS.SCR frequency (small to large effect sizes between d=0.31 and d=0.91), BCPD (small effect sizes between d=0.21 and d=0.29), and RR (small effect sizes between d=0.22 and d=0.45 ) but not on SCL and HR(V). Correlation analyses show significant but weak correlations between subjective craving and EDA (SCL: r=0.20, P=.040 and NS.SCR frequency: r=0.21, P=.027).

Conclusions:

This study adds to the research on the induction of craving and the relation between subjective and psychophysiological craving in patients with AD, informing the development of effective VR-CET, which could lead to biofeedback-VR-CET. Clinical Trial: This study followed a pre-published study protocol and was preregistered on ClinicalTrials.gov (NCT05861843).