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Background: Craving is a core symptom of cocaine use disorders (CUD). Inducing craving in exposure to substance cues is of relevant interest for numerous clinical applications. Virtual reality exposure (VRE) might be a promising candidate for improving cue-exposure paradigms but remains almost not studied for cocaine. This feasibility study’s main aim is to assess whether VRE to cocaine cues is capable to induce cocaine craving compared with VRE to neutral cues. Methods: We conducted a within-subjects controlled trial in which cocaine users performed 3 consecutive 10 mins-tasks: VRE to neutral and cocaine cues, and a relaxation-based resting procedure. The primary outcome was the change in Cocaine Craving Questionnaire-Brief (CCQ-Brief) scores between VRE to neutral and cocaine cues. Secondary outcomes included between-tasks changes in scores of cocaine craving, pleasant/unpleasant emotions as well as self-efficacy to cope with craving. Results: We recruited 11 chronic cocaine users including mostly crack smokers (45 %), cocaine snorters (36 %) and injectors (18 %), with 73 % of participants meeting DSM-IV criteria for cocaine dependence and/or abuse. Non-parametrical sign tests indicated significant large increases of CCQ-Brief scores from neutral to cocaine cue-VRE (S(11) = 11, p

Virtual reality (VR) is becoming an affordable technology and has the potential to be used in psychiatry. Cue-exposure therapy (CET) is used as an effective method in craving management in people with addiction. VR is applied for exposure simulations in CET. We are presenting a continuation of a review article published in 2019. In order to make such a review we searched for articles in the database PubMed according to key words „virtual reality & addiction"; „virtual reality & cue exposure therapy". We found 15 relevant articles published until January 10, 2021. Those articles were further divided into 3 groups. The first group includes 3 individual studies to verify the applicability of VR in opioid, cocaine and cannabis addiction. The second group consists of 7 studies to verify the applicability of VR in alcohol addiction whereas the third group consists of 5 studies to verify the use of VR in alcohol addiction treatment. Conclusion: VR allows to identify craving as well as coping with craving in a safe environment in individuals with addiction. It is necessary to prove the efficacy of VR CET in the treatment of addiction in randomized, controlled trials. [ABSTRACT FROM AUTHOR]

Background: Craving is a core symptom of cocaine use disorders (CUD). Inducing craving in exposure to substance cues is of relevant interest for numerous clinical applications. Virtual reality exposure (VRE) might be a promising candidate for improving cue-exposure paradigms but remains almost not studied for cocaine. This feasibility study's main aim is to assess whether VRE to cocaine cues is capable to induce cocaine craving compared with VRE to neutral cues., Methods: We conducted a within-subjects controlled trial in which cocaine users performed 3 consecutive 10 mins-tasks: VRE to neutral and cocaine cues, and a relaxation-based resting procedure. The primary outcome was the change in Cocaine Craving Questionnaire-Brief (CCQ-Brief) scores between VRE to neutral and cocaine cues. Secondary outcomes included between-tasks changes in scores of cocaine craving, pleasant/unpleasant emotions as well as self-efficacy to cope with craving., Results: We recruited 11 chronic cocaine users including mostly crack smokers (45 %), cocaine snorters (36 %) and injectors (18 %), with 73 % of participants meeting DSM-IV criteria for cocaine dependence and/or abuse. Non-parametrical sign tests indicated significant large increases of CCQ-Brief scores from neutral to cocaine cue-VRE (S(11) = 11, p < 0.01, Cliff's Δ = 0.65, 95 % CI: 0.17-0.88). Exploratory comparative analyses indicated significant changes after our post-cues VRE relaxation procedure, with cocaine craving and emotions restored to baseline., Conclusions: VRE to cocaine cues was feasible and capable to induce cocaine craving in cocaine users. This second VRE-based cue-reactivity study in cocaine paves the way for unexplored research on VRE clinical applications for CUD., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Alcohol use disorder (AUD) has become a major global health problem. Therapy for this condition is still a great challenge. Recently, it has become increasingly evident that computer-based training is a valuable addition to the treatment of addictive disorders., Objective: This study aims to evaluate the web-based serious game SALIENCE (Stop Alcohol in Everyday Life-New Choices and Evaluations) as an add-on therapy for AUD. It combines the cue-exposure therapy approach with elements of decision-making training, enhanced by interactive panoramic images. The effects of SALIENCE training on levels of craving, attention, and cognitive bias are investigated., Methods: In a randomized controlled trial, 62 participants with AUD undergoing 3 weeks of an extended alcohol detoxification program were randomly allocated to an intervention and a control group. A total of 49 individuals (mean age 44.04 y; 17/49, 35% female) completed all sessions and were included in the analysis. Only pretreatment data were available from the other 13 patients. Participants answered questionnaires related to alcohol consumption and craving and completed neuropsychological tasks at the beginning of the study and 2 weeks later to evaluate levels of attention and cognitive biases. During the 2-week period, 27 of the participants additionally performed the SALIENCE training for 30 minutes 3 times a week, for a total of 6 sessions., Results: We observed a significant decrease in craving in both groups: the control group (mean 15.59, SD 8.02 on the first examination day vs mean 13.18, SD 8.38 on the second examination day) and the intervention group (mean 15.19, SD 6.71 on the first examination day vs mean 13.30, SD 8.47 on the second examination day; F 1,47 =4.31; P=.04), whereas the interaction effect was not statistically significant (F 1,47 =0.06; P=.80). Results of the multiple linear regression controlling for individual differences between participants indicated a significantly greater decrease in craving (β=4.12; t 36 =2.34; P=.03) with the SALIENCE intervention. Participants with lower drinking in negative situations reduced their craving (β=.38; t 36 =3.01; P=.005) more than people with higher drinking in negative situations., Conclusions: The general effectiveness of SALIENCE training as an add-on therapy in reducing alcohol craving was not confirmed. Nevertheless, taking into account individual differences (gender, duration of dependence, stress, anxiety, and drinking behavior in different situations), it was shown that SALIENCE training resulted in a larger reduction in craving than without. Notably, individuals who rarely consume alcohol due to negative affect profited the most from SALIENCE training. In addition to the beneficial effect of SALIENCE training, these findings highlight the relevance of individualized therapy for AUD, adapted to personal circumstances such as drinking motivation., Trial Registration: ClinicalTrials.gov NCT03765476; https://clinicaltrials.gov/show/NCT03765476., (©Antonia Weber, Yury Shevchenko, Sarah Gerhardt, Sabine Hoffmann, Falk Kiefer, Sabine Vollstädt-Klein. Originally published in JMIR Formative Research (https://formative.jmir.org), 07.11.2023.)

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. [ABSTRACT FROM AUTHOR]

Cue-exposure therapy (CET) is an effective approach for anxiety-related disorders, but its effectiveness for substance use disorders is less clear. One potential means of improving CET outcomes is to include a cognitive-enhancing pharmacotherapy. This study evaluated d -cycloserine (DCS) and RY-023, putative cognitive enhancers targeting glutamate and GABA systems, respectively, in a monkey model of CET for alcohol use disorder. Male rhesus monkeys (n = 4) underwent multiple cycles of the CET procedure. During baseline (Phase 1), monkeys self-administered an ethanol solution under a fixed-ratio schedule and limited access conditions such that every 5th response in a 3-h session resulted in 30-s access to a drinking spout and a change in ethanol-paired cue lights from white to red. Behavior then was extinguished (Phase 2) by omitting the ethanol solution yet retaining the ethanol-paired stimulus lights. Monkeys also received injections of vehicle, DCS (3 mg/kg), a partial agonist at the glycine modulatory site on glutamatergic NMDA receptors, or the α5GABA A receptor-selective inverse agonist RY-023 (0.03 or 0.3 mg/kg). Once responding declined, monkeys underwent a cue reactivity test (Phase 3), and then returned to self-administration the following day to assess reacquisition (Phase 4). Through multiple cycles, self-administration remained stable. Compared to vehicle, DCS facilitated extinction of ethanol seeking (Phase 2) and delayed reacquisition of ethanol self-administration (Phase 4). In contrast, RY-023 facilitated extinction (Phase 2) and reduced cue reactivity (Phase 3). Adjunctive pharmacotherapy can improve CET outcomes, but the choice of pharmacotherapy should be dependent on the outcome of interest. • Adjunctive pharmacotherapies may improve outcomes of cue-exposure therapy (CET). • D -cycloserine facilitated extinction and slowed resumption of self-administration. • RY-023 facilitated extinction and attenuated cue reactivity. • Glutamatergic and GABAergic compounds differentially enhance specific CET outcomes. [ABSTRACT FROM AUTHOR]

Reward cues can contribute to overconsumption of food and drugs and can relapse. The failure of exposure therapies to reduce overconsumption and relapse is generally attributed to the context-specificity of extinction. However, no previous study has examined whether cue-elicited reward-seeking (as opposed to cue-reactivity) is sensitive to context renewal. We tested this possibility in 160 healthy volunteers using a Pavlovian-instrumental transfer (PIT) design involving voluntary responding for a high value natural reward (chocolate). One reward cue underwent Pavlovian extinction in the same (Group AAA) or different context (Group ABA) to all other phases. This cue was compared with a second non-extinguished reward cue and an unpaired control cue. There was a significant overall PIT effect with both reward cues eliciting reward-seeking on test relative to the unpaired cue. Pavlovian extinction substantially reduced this effect, with the extinguished reward cue eliciting less reward-seeking than the non-extinguished reward cue. Most interestingly, extinction of cue-elicited reward-seeking was sensitive to renewal, with extinction less effective for reducing PIT when conducted in a different context. These findings have important implications for extinction-based interventions for reducing maladaptive reward-seeking in practice. [ABSTRACT FROM AUTHOR]

Recent research addressing the use of music to support the needs of people receiving treatment for drug addiction has led to the development and implementation of music-assisted therapeutic interventions. We hypothesized that two different music modalities combined with systematic desensitization can counter-condition drug-related cues and significantly reduce the associated craving responses. We further examined the effect of the two treatments on cognitive and psychopathological components of addiction. Twenty-four individuals experiencing drug addiction were randomly assigned to one of the three study groups, namely systematic desensitization (SD) combined with listening to New Age meditation music improvised live on Tibetan bowls (IMT), systematic desensitization combined with listening to relaxing New Age music recorded in individual MP3 devices (NIMT), or a control group that received no additional therapeutic intervention (CTR). Participants in the two treatment groups received six sessions in addition to their standard treatment during a period of three weeks. Evaluation took place at baseline, post-treatment and one month after the end of treatment. Results showed that IMT and NIMT combined with SD significantly reduced craving in response to external drug-conditioned cues, while IMT appeared to be slightly more effective than NIMT in altering permissive thoughts on drug and alcohol use, depression symptoms and everyday life craving reactivity. Further investigation as to the role of music-assisted systematic desensitization as a therapeutic intervention for drug addiction treatment is warranted. [ABSTRACT FROM AUTHOR]

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.

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. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this study was to test if cue-exposure therapy (CET) combined with biofeedback therapy (BT) could decrease craving and physiological reactivity to drug-related cues in heroin dependents. Forty-five participants were randomly assigned to usual rehabilitation with or without CET combined with BT. Craving was assessed by a 100-point visual analog scale (VAS). Skin conductance (SC) and muscle electromyography (MEG) were recorded using a biofeedback device. After 2months of treatment, both the pre-cue exposure craving and the post-cue exposure craving, SC, and MEG were lower in the experimental group than in the control group. Compared to the control group, the experimental group had a greater decrease in craving, SC, and MEG from baseline after the treatment. The results suggest that CET combined with BT treatment is effective in reducing craving and physiology reactivity in heroin dependents and could be used as a component of heroin-dependence rehabilitation. [Copyright &y& Elsevier]

This study shows preliminary data on the validity of a new virtual reality-based application for cue-exposure treatment of binge eating in bulimia nervosa and binge eating disorder. Thirty-eight undergraduate students without eating disorders were exposed to several virtual environments with different foods in four different contexts (kitchen, dining-room, bedroom, and bakery/café). Participants were asked to indicate the level of food craving experienced in each situation. They also completed the Spanish version of the State and Trait Food Cravings Questionnaires. The results suggest that virtual reality is an effective technology for eliciting food craving, especially in the case of participants with high reactivity to food cues, and those who were hungry or experienced strong desire to eat during the experiment. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Drug abuse remains costly. Drug- related cues can evoke cue-reactivity and craving, contributing to relapse. The Pavlovian extinction-based cue-exposure therapy (CET) has not been very successful in treating drug abuse. A functional operant analysis of complex rituals involved in CET is outlined and reinterpreted as an operant heterogeneous chain maintained by observing responses, conditioned reinforcers, and discriminative stimuli. It is further noted that operant functions are not predicated on Pavlovian processes but can be influenced by them in contributing to relapse; several empirical studies from the animal and human literature highlight this view. Cue-reactivity evoked by Pavlovian processes is conceptualized as an operant establishing/ motivating operation. CET may be more effective in incorporating an operant-based approach that takes into account the complexity of Pavlovian-operant interaction. Extinction of the operant chain coupled with the shaping of alternative behaviors is proposed as an integrated therapy. It is proposed that operant- based drug abuse treatments (contingency management, voucher programs, and the therapeutic work environment) might consider incorporating cue-reactivity, as establishing/motivating operations, to increase long-term success--a hybrid approach based on Pavlovian--operant interaction. [ABSTRACT FROM AUTHOR]

Extinction and recovery of the discriminative stimulus effects of nicotine (0.3 mg/kg) was investigated with a devalued food reinforcer (rats sated). Sixteen rats were trained in a counterbalanced one manipulandum (nose-poke) drug discrimination procedure with the roles of nicotine and saline counterbalanced as SD and SΔ. Discrimination training was maintained and then extinguished with the devalued reinforcer. Devaluation of the reinforcer diminished SΔ response rates during discrimination training but not discriminative control. Following delays after extinction, recovery of responding occurred with the revalued but not devalued reinforcer. These data demonstrate that (a) discriminative control by nicotine is temporally stable with a devalued reinforcer following acquisition and extinction, (b) revaluation of the reinforcer promotes recovery of discriminative control, and (c) recovery of interoceptive discriminative control by nicotine following extinction is affected by changes in motivation. Theoretical implications regarding drug replacement therapy and cue-exposure therapy are discussed. [ABSTRACT FROM AUTHOR]