An explorative single-arm clinical study to assess craving in patients with alcohol use disorder using Virtual Reality exposure (CRAVE)-study protocol

• Published in: BMC psychiatry Vol. 23; no. 1; pp. 839 - 8
• Main Authors: Lütt, A, Tsamitros, N, Wolbers, T, Rosenthal, A, Bröcker, A L, Schöneck, R, Bermpohl, F, Heinz, A, Beck, A, Gutwinski, S
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 14.11.2023; BioMed Central; BMC
• Subjects: Acamprosate; Alcohol Drinking; Alcohol use; Alcohol Use Disorder; Alcoholism - psychology; Alcoholism - therapy; Behavioral health care; Clinical trials; Cognitive ability; Cognitive therapy; Comorbidity; Computer applications; Cost estimates; Craving; Cue Exposure Therapy; Cues; Drinking of alcoholic beverages; Habituation; Health aspects; Heart beat; Heart rate; Heart rate variability; Hospitals; Humans; Long-term effects; Medical innovations; Medical research; Medicine, Experimental; Motion sickness; Patients; Physiology; Psychiatry; Psychophysiological parameters; Questionnaires; Recurrence; Virtual Reality; Germany; Electrodermal activity; Alcohol Use Disorder; Craving; Cue Exposure Therapy; Pupillometry; Psychophysiological parameters; Heart rate variability; Virtual Reality
• ISSN: 1471-244X; 1471-244X
• DOI: 10.1186/s12888-023-05346-y

Alcohol use disorder (AUD) belongs to the most burdensome clinical disorders worldwide. Current treatment approaches yield unsatisfactory long-term effects with relapse rates up to 85%. Craving for alcohol is a major predictor for relapse and can be intentionally induced via cue exposure in real life as well as in Virtual Reality (VR). The induction and habituation of craving via conditioned cues as well as extinction learning is used in Cue Exposure Therapy (CET), a long-known but rarely used strategy in Cognitive Behavioral Therapy (CBT) of AUD. VR scenarios with alcohol related cues offer several advantages over real life scenarios and are within the focus of current efforts to develop new treatment options. As a first step, we aim to analyze if the VR scenarios elicit a transient change in craving levels and if this is measurable via subjective and psychophysiological parameters. A single-arm clinical study will be conducted including n = 60 patients with AUD. Data on severity of AUD and craving, comorbidities, demographics, side effects and the feeling of presence in VR will be assessed. Patients will use a head-mounted display (HMD) to immerse themselves into three different scenarios (neutral vs. two target situations: a living room and a bar) while heart rate, heart rate variability, pupillometry and electrodermal activity will be measured continuously. Subjective craving levels will be assessed before, during and after the VR session. Results of this study will yield insight into the induction of alcohol craving in VR cue exposure paradigms and its measurement via subjective and psychophysiological parameters. This might be an important step in the development of innovative therapeutic approaches in the treatment of patients with AUD. This study was approved by the Charité-Universitätsmedizin Berlin Institutional Review Board (EA1/190/22, 23.05.2023). It was registered on ClinicalTrials.gov (NCT05861843).