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Continuous maladaptive drug-related memories that are resistant to extinction and cause drug-seeking behaviors to be triggered are known to be one of the hallmarks of drug addiction (1). These drug-related memories are salient, strong, and persistent due to chronic maladaptive consolidation processes. Due to the salient content of drug-related memories formed during drug-taking behaviors, certain stimuli (e.g., peers, locations, paraphernalia) become encoded with reward contingencies associated with drugs. As a result of this learning processing, drug-paired stimuli acquire incentive motivational properties that change them into salient cues (2). According to Pavlovian conditioning, consequent exposure to these stimuli (Henceforth called drug cues) activates the original memories and evokes craving. This enhanced retrieval co-occurs with the activation of limbic cortico-striatal pathways involved in reward processing (3). A serious question in addiction neuroscience is whether these memories could be actively erased/reshaped in favor of the recovery process. Different research groups suggested various treatment strategies during the last decade to modulate these memories. Here in this short opinion paper, we propose a novel framework titled “Cue-induced Retrieval and Reconsolidation with Episodic Foresight” (CIREF) that aims to combine three different cognitive interventions, i.e., cue-exposure, memory reconsolidation, and episodic future thinking, to reshape these maladaptive drug-related memories toward more adaptive memories to support addiction recovery. Published version

This case study describes the use of a virtual reality-based cue-exposure therapy (VR-CET) for a patient diagnosed with bulimia nervosa (BN) who was resistant to standard cognitive behavioral therapy (CBT). After six VR-CE booster sessions, both anxiety and food craving dropped significantly. No binging and purging episodes were reported at the end of the treatment. Patient’s mood and confidence to change were also improved. Finally, both eating symptoms and food craving were reduced at the end of the VR-CET. These results support the use of VR-CE as an effective component for the treatment of BN to reduce bulimia symptoms, body dissatisfaction and craving, especially in patients resistant to conventional treatments.

The objective of this study was to identify frequent situations and specific cues that produce the craving to binge in Spanish and Italian samples of patients with eating disorders (ED). There were two main aims: to assess transcultural differences in the contexts and cues that elicit food craving; and to develop valid, reliable VR environments for effective cue-exposure therapy (CET) for patients from both countries. Twenty-six Spanish and 75 Italian ED patients completed an ad hoc questionnaire to assess contexts and cues that trigger the craving to binge. No differences between groups were found. All patients reported experiencing higher levels of craving in the afternoon/early evening and in the late evening/night, between meals, when alone, and more frequently at the end of the week. Being in the dining room, the kitchen, the bedroom, the bakery and the supermarket were the specific situations that produced the highest levels of craving to binge. We used the questionnaire results to develop a virtual reality application for CET.

The objective of this study was to identify frequent situations and specific cues that produce the craving to binge in Spanish and Italian samples of patients with eating disorders (ED). There were two main aims: to assess transcultural differences in the contexts and cues that elicit food craving; and to develop valid, reliable VR environments for effective cue-exposure therapy (CET) for patients from both countries. Twenty-six Spanish and 75 Italian ED patients completed an ad hoc questionnaire to assess contexts and cues that trigger the craving to binge. No differences between groups were found. All patients reported experiencing higher levels of craving in the afternoon/early evening and in the late evening/night, between meals, when alone, and more frequently at the end of the week. Being in the dining room, the kitchen, the bedroom, the bakery and the supermarket were the specific situations that produced the highest levels of craving to binge. We used the questionnaire results to develop a virtual reality application for CET.

Objective: To examine whether cue-exposure therapy increases the effectiveness of a multicomponent smoking cessation program that combines cognitive-behavioral techniques with nicotine patches. Method: Pre-post-follow-up quasi-experimental study of two groups, one group of 22 smokers that received a multicomponent group smoking cessation program that combined cognitive-behavioral techniques with nicotine patches and other group of 26 smokers that received a similar program that also included in vivo exposure to smoking-related cues and contexts and daily self exposure homework. Results: The program with cue-exposure therapy showed higher abstinence rates at post-treatment, 1-month follow-up, 6-month follow-up and one-year follow-up than those showed by the program without cue-exposure therapy (65,4%, 65,4%, 66,7% and 66,7%, respectively, versus 59,1%, 59,1%, 40,9% and 36,4%), however, the differences were not statistically significant. Conclusions: It seems that cue-exposure therapy does not significantly increase the abstinence rates of a multicomponent smoking cessation program that combines cognitive-behavioral techniques with nicotine patches. However, this conclusion should be taken with caution because the present study used a cuasi-experimental design (instead of an experimental one) and is based on a small number of smokers. In this sense, it is likely that this study lacked statistical power since differences so large as the 25-30 percentage points found at the six-month and one-year follow-ups did not reach statistical significance.

Eating behavior style (emotional, restrictive, or external) has been proposed as an explanation for the differences in response to food-related cues between people who overeat and those who do not, and has been also considered a target for the treatment of eating disorders (EDs) characterized by lack of control over eating and weight-related (overweight/obesity) conditions. The aim of this study was to analyze the relationship between eating behavior style and psychophysiological responses (self-reported food craving and anxiety) to food-related virtual reality (VR) environments in outpatients with bulimia nervosa (BN) and binge eating disorder (BED) and to compare them with healthy participants. Fifty-eight outpatients and 135 healthy participants were exposed to palatable foods in four experimental everyday real-life VR environments (kitchen, dining room, bedroom and café). During exposure, cue-elicited food craving and anxiety were assessed. Participants also completed standardized instruments for the study purposes. ED patients reported significantly higher levels of craving and anxiety when exposed to the virtual food than healthy controls. Eating behavior styles showed strong associations with cue-elicited food craving and anxiety. In the healthy group, external eating was the only predictor of cue-elicited craving and anxiety. In participants with BN and BED, external and emotional eating were the best predictors of cue-elicited craving and anxiety, respectively.

The aim of this study was to establish whether virtual reality (VR) exposure to food cues is able to produce craving levels consistent with state-craving and trait-craving as assessed by the Spanish and Italian versions of the State and Trait Food Craving Questionnaires (FCQ-T/S). The results were compared in 40 patients with eating disorders (17 with binge eating disorder, 23 with bulimia nervosa) and 78 healthy control subjects without eating disorders. Controls and patients with higher levels of trait-craving and state-craving both showed a greater desire to eat during VR exposure. Results also showed that trait and state craving assessed by FCQ-T/S were able to predict the total mean craving experienced during exposure to the VR software in both clinical and control samples. These findings present preliminary evidence about the validity of a new virtual reality-based application for cue- exposure treatment in patients with eating disorders.