Abstract
(1) Background: Virtual reality (VR) has been investigated in a variety of psychiatric disorders, including addictive disorders (ADs); (2) Objective: This systematic review evaluates the current evidence of immersive VR (using head-mounted displays) in the clinical assessment and treatment of ADs; (3) Method: PubMed and PsycINFO were queried for publications up to November 2020; (4) Results: We screened 4519 titles, 114 abstracts and 85 full-texts, and analyzed 36 articles regarding the clinical assessment (i.e., diagnostic and prognostic value; n = 19) and treatment (i.e., interventions; n = 17) of ADs. Though most VR assessment studies (n = 15/19) showed associations between VR-induced cue-reactivity and clinical parameters, only two studies specified diagnostic value. VR treatment studies based on exposure therapy showed no or negative effects. However, other VR interventions like embodied and aversive learning paradigms demonstrated positive findings. The overall study quality was rather poor; (5) Conclusion: Though VR in ADs provides ecologically valid environments to induce cue-reactivity and provide new treatment paradigms, the added clinical value in assessment and therapy remains to be elucidated before VR can be applied in clinical care. Therefore, future work should investigate VR efficacy in randomized clinical trials using well-defined clinical endpoints.
Highlights
Given the limitations of previous reviews and the high speed of development in the Virtual reality (VR) field, including its application in addictive disorders (ADs), the current review aims to evaluate the clinical relevance of VR in the assessment and treatment of ADs
Three additional resources were identified through the backward citation search for eligible papers, and 49 papers were excluded because the studies did not use immersive VR through HMDs (n = 20), ineligible outcomes were reported (n = 18), an ineligible study design was employed (n = 9), population without AD or daily/heavy use (n = 1), or the paper was written in a different language than English (n = 1)
Regarding VR-assessment, our findings show that cue-reactivity paradigms might be of diagnostic value in patients with nicotine, alcohol and methamphetamine use disorder, as well as gaming disorder
Summary
Addictive disorders (ADs), including both substance use disorders (SUDs) and behavioral addictions, are among the most prevalent psychiatric conditions with the highest global mental disease burden besides depression [1]. The prevalence of ADs varies across various substances: alcohol (4.9%), psychoactive drugs (0.2–3.5%), problematic gambling (1.5%) and tobacco use (22.5%) [2]. Tobacco-dependence related predictors: Pericot-Valverde et al (2015) [47]. VR2 study with focus on individual predictors of effectiveness with pre-post session evaluation. VR2 study with focus on application in natural treatment setting with pre-post session evaluation. - TS, cigarettes/day = 17.7, FTND = 4.9 (n = 32). - Individualized VRET as in Pericot-Valverde et al. VR2 study into adherence and preliminary effectiveness with pre-follow up evaluation and randomized controlled design.
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