Abstract
Virtual reality (VR) can be used in the treatment of gambling disorder to provide emotionally charged contexts (e.g., induce cravings) where patients can practice cognitive behavior therapy (CBT) techniques in the safety of the therapist’s office. This raises practical questions, such as whether the cravings are sufficient to be clinically useful but also manageable enough to remain clinically safe. Pilot data are also needed to test the development of a treatment manual and prepare large randomized control trials. This paper reports on three studies describing (a) cravings induced in VR compared to real gambling and a control game of skill with no money involved (N = 28 frequent gamblers and 36 infrequent gamblers); (b) the usefulness of a treatment protocol with only two CBT sessions using VR (N = 34 pathological gamblers); and (c) the safety of a four-session treatment program of CBT in VR (N = 25 pathological gamblers). Study 1 reveals that immersions in VR can elicit desire and a positive anticipation to gamble in frequent gamblers that are (a) significantly stronger than for infrequent gamblers and for playing a control game of skill and (b) as strong as for gambling on a real video lottery terminal. Study 2 documents the feasibility of integrating VR in CBT, its usefulness in identifying more high-risk situations and dysfunctional thoughts, how inducing cravings during relapse prevention exercises significantly relates to treatment outcome, and the safety of the procedure in terms of cybersickness. Results from Study 3 confirm that, compared to inducing urges to gamble in imagination, using VR does not lead to urges that are stronger, last longer, or feel more out of control. Outcome data and effect sizes are reported for both randomized control pilot trials conducted in inpatient settings. Suggestions for future research are provided, including on increasing the number of VR sessions in the treatment program.
Highlights
Stéphane Bouchard1,2*, Geneviève Robillard1, Isabelle Giroux3, Christian Jacques3, Claudie Loranger2, Manon St-Pierre2, Maxime Chrétien3 and Annie Goulet3
This paper reports on three studies describing (a) cravings induced in Virtual reality (VR) compared to real gambling and a control game of skill with no money involved (N = 28 frequent gamblers and 36 infrequent gamblers); (b) the usefulness of a treatment protocol with only two cognitive behavior therapy (CBT) sessions using VR (N = 34 pathological gamblers); and (c) the safety of a four-session treatment program of CBT in VR (N = 25 pathological gamblers)
The goal of this paper is to document the potential of VR in the CBT of gambling disorder (GD) with three consecutive studies that are as follows: (a) an experimental demonstration that VR immersions can induce cravings in GD patients (Study 1); (b) a pilot study documenting the potential of a minimal use of VR in CBT for GD (Study 2); and (c) a second pilot trial to gage the safety, in terms of the intensity of cravings, of a slightly more intensive use of VR in CBT for GD (Study 3)
Summary
Stéphane Bouchard1,2*, Geneviève Robillard, Isabelle Giroux, Christian Jacques, Claudie Loranger, Manon St-Pierre, Maxime Chrétien and Annie Goulet. Virtual reality (VR) can be used in the treatment of gambling disorder to provide emotionally charged contexts (e.g., induce cravings) where patients can practice cognitive behavior therapy (CBT) techniques in the safety of the therapist’s office. This raises practical questions, such as whether the cravings are sufficient to be clinically useful and manageable enough to remain clinically safe. This paper reports on three studies describing (a) cravings induced in VR compared to real gambling and a control game of skill with no money involved (N = 28 frequent gamblers and 36 infrequent gamblers); (b) the usefulness of a treatment protocol with only two CBT sessions using VR (N = 34 pathological gamblers); and (c) the safety of a four-session treatment program of CBT in VR (N = 25 pathological gamblers). The lack of correlation between the place where CBT takes place—i.e., the therapist’s office—and the day-to-day reality of gamblers becomes evident when it comes to the cravings and emotional responses felt by people suffering from addictive disorders when they encounter high-risk situations [3, 11]
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