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The application of virtual reality (VR) as a supportive tool in psychotherapy has gained great popularity in recent years. Especially for addiction therapy, a combination of virtual exposure and learning or training coping skills by using biofeedback has a high potential to improve conventional therapy. To add value, the new therapy system has to meet the needs of patients and practitioners likewise. Added values consistently named by experts included, but were not limited to, new possibilities of creating individual exposition or coping scenarios, enhanced psychoeducation, a shorter duration of treatment, telemedical aspects, the possibility of measuring and predicting craving and finally an improvement in abstinence. Besides literature research, we evaluated existing technical solutions in the field of virtual addiction treatment, surveyed experts and evolved a concept that led to a first prototype. The prototype consists of a wireless VR headset and a wireless multi-sensor system for measuring the physiological reaction to stimuli or the effectiveness of coping strategies by means of biofeedback. For further studies we developed both, a virtual exposure and a coping scenario and tested the hardware and software in a pilot study in order to elaborate factors that could negatively affect the therapy adherence, the effectiveness of exposition (immersion) and possible hurdles in practical use. Cybersickness and the lack of haptic feedback turned out to be the main limiting factors. Concepts for the next iteration of the therapy system will reflect these points for upcoming clinical studies. In our proof of concept, we demonstrated that virtual therapy can be implemented with a reasonable effort of time and costs. The combination of software and hardware, that supplements the traditional therapeutic approach, lays the foundation for upcoming clinical use and trials to prove the better outcome of VR enhanced addiction therapy.

After the success of virtual reality (VR) applications in supporting exposure-based and psychoeducational cognitive behavioural therapy for various mental illnesses, the technology is also gaining traction in addiction medicine. This paper will describe the concept behind a custom-developed VR simulation for this application with a particular emphasis on alcohol-related addictive disorders. Using Unreal Engine 4, an exposure simulation and a scenario for learning and applying coping strategies were developed for the Oculus Quest. Because of the common association of supermarkets with the procurement of alcohol among addicts, a small shop was implemented as initial scenario. Since the feeling of presence is an important parameter in the quality assessment of a simulation, the degree of immersion was evaluated in initial practical tests after development. In surveys with ten healthy testers, the majority showed a feeling of immersion. Cybersickness and unrealistic collision physics were identified as disruptive factors to the extent of immersion. This work provides the basis for a novel concept for addiction therapy which focusses on a fusion of playful psychoeducation, adjustable exposure, and the internalization of coping strategies with the help of multisensory biofeedback as well as the documentation of the objective physiological measurements for assessment of therapy success. The aim is to best possible address the specific requirements for clinical and home use in terms of self-containment, immersion, and ease of use. To evaluate and exploit the scientific potential of this concept scientific studies and technical improvements to both simulation and hardware are required.

Besides entertainment, Virtual Reality (VR) is becoming increasingly important for professional applications. VR offers a wide range of use, from simulating and dealing with critical or dangerous situations or procedures, competence-oriented learning and testing in an educational context, diagnostic or therapeutic applications in the medical field, or even for tele manipulators and robotics. In most of the mentioned scenarios, measuring the alertness, mental load, stress or relaxation state of the user would be a clear enhancement. That information can serve as a valuable input to control or influence the VR-setting (e.g. for biofeedback) or lead to additional information, for instance as an countable outcome of a simulation or for objectifiable results that can be used for debriefing or diagnostics. Since stress mirrors a neurophysiological response, it is possible to measure the reaction of the human body to a stressor. This leads to the activation of the autonomous nervous system that controls many different physical reactions. To find the best parameter measuring the timing of a sympathetic activation to a predefined stressor (especially with regards to our research of detecting substance craving precisely after a virtual exposure for a VR-based therapy system in addiction medicine), electroencephalography (EEG), heart rate variability (HRV), skin conductance response (SCR), and peripheral skin temperature (ST) were compared against each other regarding a real-time detection of stress among criteria such as the costs for building a wireless sensor, the ease of use in a professional, medical or home use and the robustness against artifacts and the precision of the measurement. We used a 180-degree horror movie as a stressor for a healthy study population and took care about possible confounders, that may influence the subject's stress level or the measurements. All measurement procedures and the used devices complied with medical standards. It was possible to provoke a measurable physiological stress reaction in all subjects through VR, although not all participants subjectively felt scared or stressed. EEG, SCR and peripheral skin temperature turned out to be equally well suited for real-time detection of stress. HRV failed to reliably show the stress response, which does not disqualify this measuring method, but might rather be connected with measurement timeframes and data preparation in our study. When it comes to the ease of use, the robustness of the measurement, costs and the possibility to implement the measuring technique within a wireless system (e.g., finger clips or even the VR hand controllers), we consider the skin conductance response (SCR) as the most promising physiological parameter to objectify stress in a virtual environment. • A stressor applied in VR leads to a physiological and measurable stress reaction. • Electroencephalography (EEG), electrodermal activity (EDA) and the peripheral skin temperature (ST) are suitable for detecting stress. • EDA performed best in regard to data quality and professional and medical requirements. [ABSTRACT FROM AUTHOR]