Virtual reality therapy for alcohol relapse prevention

Abstract

Alcohol misuse affects a large part of the population worldwide, often transforming to a chronic, relapsing condition, and contributes to economic costs to health and social care and other state services, hampering the achievement of sustainable development goals. An important part of alcohol treatments would typically focus on Relapse Prevention (RP) - helping people to develop relevant coping skills in high-risk situations that challenge abstinence. Exposure to personalised and realistic high-risk situations for practising coping within them can be challenging in clinical contexts. Virtual Reality Therapy (VRT) could offer immersive and controlled exposure to high-risk situations via their simulation as Virtual Environments (VEs). VRT could also increase treatment accessibility, being delivered online or via low-immersion VR set-ups for cost-effectiveness. Preliminary evidence suggests VRT’s effectiveness on changing alcohol craving levels and alcohol-related attitudes. How to integrate VRT into current clinical practice for addressing specifically RP or other parts of alcohol treatment has not been explored. An interview study was, thus, conducted with practitioners and researchers delivering or designing substance use treatments, to determine VRT’s clinical acceptability as a treatment tool in practitioners and identify the preferred content and functionality of a VRT application for RP and appropriate delivery protocols. Via a survey study with adults drinking at diverse levels, the relative treatment preference for and treatment acceptability of VRT (delivered either via standard VR headset or via mobile - mVRT) were explored compared to current, alcohol treatments in the UK, in order to identify factors of VRT’s acceptability that should be considered in the design of its delivery protocols for increasing treatment uptake and engagement. A VRT application (“A-PLAN”) was developed, that simulated common, high-risk situations, whose design was guided by practitioners’ and researchers’ suggestions and prior VEs assessed effective in literature for alcohol treatment, to test the suitability of these contexts for RP. Via an online, interview study with low- and high-risk drinkers, “A-PLAN” was assessed about its realism and its capacity to induce alcohol temptation in a cost-effective, VR setting, in order to refine its content for RP and explore the therapeutic potential of low-immersion, cost-effective VR set-ups. The combined findings of these studies informed the clinical application of VRT for RP, facilitating recommendations about its delivery protocol and the content and the functionality that a VRT application for RP should involve. Discussion and reflection on aspects of the delivery protocol and the application design that should be considered when clinically employing VRT for RP, with a focus on their associations with acceptability, therapeutic effectiveness, cost-effectiveness and accessibility, were also included. The reported findings, discussions and conclusions could inform future research and applications of VRT for RP and for alcohol treatment generally. The mixed research approach followed, involving qualitative and quantitative studies, could inform and quicken the design process of novel, technological treatments tools and lead to their purposeful integration into relevant clinical practices.

Ανάπτυξη εφαρμογής εικονικής πραγματικότητας για χρήση ως θεραπευτικό εργαλείο στο στάδιο πρόληψης υποτροπής στην θεραπεία του αλκοολισμού. Διερευνήθηκαν μέσω ποιοτικής και ποσοτικής έρευνας: (1) η αποδοχή της VRT από τους ψυχολόγους που εξειδικεύονται στην θεραπεία κατάχρησης ουσιών και ψυχικών διαταραχών, (2) η αποδοχή της VRT από άτομα διαφορετικών επιπέδων κατάχρησης αλκοόλ και (3) τα στοιχεία της εφαρμογής ως προς το περιεχόμενό της που επηρεάζουν τον ρεαλισμό και την επιθυμία χρήσης αλκοόλ των εξαρτημένων ατόμων συγκριτικά με τα μη εξαρτημένα από το αλκοόλ άτομα. Προτάθηκαν θεραπευτικά σχήματα που προάγουν την ενσωμάτωση της VRT κλινικά, με απώτερο στόχο την επακόλουθη επικύρωση τους από εξειδικευμένες, κλινικές έρευνες.