3. Immersive Virtual Reality in the Assessment and Treatment of Addictive Disorders: Current Status and Future Perspectives

Immersive Virtual Reality (IVR) has been studied in the assessment and treatment of various psychiatric disorders, including addictive disorders (ADs). IVR enables patients with AD to feel present in safe and controllable contexts that provoke cue reactivity (i.e. cravings, physiological responses) with high ecological validity. This enables scholars to build therapeutical paradigms on top focusing on 'doing instead of talking', especially relevant for vulnerable patients that do not profit from regular treatments (e.g. low health literacy, developmental disabilities, or psychiatric comorbidities).

We present the current evidence of IVR (using head-mounted displays) for clinical applications in ADs. We performed a systematic review by querying the databases PubMed and PsycINFO until November 2020. We analyzed 36 articles focusing on the assessment (i.e., diagnostic and prognostic value; n = 19) and treatment (i.e., interventions; n = 17). Furthermore, we demonstrate building blocks for IVR addiction therapy in vulnerable groups derived from our work with stakeholders.

− Though most assessment studies (n = 15/19) showed associations between IVR cue reactivity and clinical parameters, only two studies specified the diagnostic value. IVR interventions based on exposure therapy (VRET) showed no or negative effects. However, other interventions such as embodied and aversive learning paradigms showed positive findings, though significantly less investigated. The overall study quality was rather poor and not at a clinical level.

− Building blocks for vulnerable groups include (1) assessment (risk situations, trigger, craving, bodily signals), and (2) treatment (raising awareness, embodied learning, training and rehearsing coping strategies, practicing clinical leave).

− The benefits of IVR in clinical practice remain to be elucidated for both, clinical assessment and treatment, before IVR can be applied in care. To move the field forward, studies with clear clinical endpoints and scientific quality, including randomized controlled designs and adequate follow-up, are required.

− Future work should focus on the identification and implementation of therapeutic elements in IVR (e.g., coping skills training, mindfulness) and the related development of treatment protocols with active (embodied) learning practices, instead of passive approaches that aim for extinction (VRET). Furthermore, adverse effects (e.g. cybersickness), ethical concerns, and privacy issues should be considered thoroughly.