Virtual reality approach bias modification during alcohol withdrawal treatment
Overview
ABM involves training people to ‘push away’ pictures of alcohol and ‘pull closer’ pictures of healthier choices. This is designed to reduce people’s automatic impulses to drink alcohol. Our previous research has shown that ABM can help people avoid drinking again after treatment.
ABM is usually done using joysticks and computers, but many people find it boring. We hoped the more ‘immersive’ 3-D experience of VR would make ABM more engaging. Since this was the first time anyone has tried delivering VR-ABM during withdrawal treatment, we also wanted to test whether it was safe, acceptable, and feasible (easy to complete) for patients.
We recruited 29 people who were receiving inpatient alcohol withdrawal treatment. We aimed for participants to complete 4 VR-ABM sessions during their withdrawal admission. We used questionnaires and interviews to assess how safe and comfortable the VR experience was, whether people liked it, and whether their craving changed after VR-ABM training. We also interviewed participants to understand their experiences of the VR-ABM in more depth, including how they felt it compared to doing ABM on a computer or smartphone. We also phoned participants twice (1 month and 3 months after they left inpatient treatment) to assess whether they used any alcohol after treatment.
The results regarding safety and acceptability of VR-ABM were mostly positive. On average, participants’ distress reduced after VR-ABM sessions. There were only minimal reports of physical symptoms that can sometimes occur when using VR (like dizziness, nausea, or arm fatigue). Participants generally reported that the VR training was acceptable and enjoyable.
Participants who completed interviews comparing different types of ABM (VR, computer, and smartphone) generally felt that VR-ABM was more engaging, immersive, and emotionally-resonant than computer or smartphone-based ABM. However, they saw smartphone ABM as having some advantages because it was easy to access and use, and it had familiar aspects, such as using “swiping” motions similar to those in other apps. Computer-based ABM was usually seen as the worst of the 3 types, being perceived as “clunky” to use and boring.
However, fitting all 4 sessions of VR-ABM training into a short inpatient stay was less feasible than we hoped. Only around half of participants completed all 4 sessions. The most common reason for not completing all 4 sessions was that many participants left inpatient treatment earlier than expected. Additionally, a small number of participants (10%) stopped participating because they felt the VR environment or the images used in the training were too overwhelming. Hence, while VR-ABM seemed to be safe for most participants, there may be some people for whom it’s less suitable, at least in the early stage of withdrawal treatment.
Participants’ craving levels reduced significantly between the first and final session of ABM. The number of participants who remained alcohol-free at the 1-month and 3-month follow-ups was similar to what we have seen in previous studies involving people in alcohol withdrawal treatment, so it was unclear if VR-ABM had any long-term benefits. Since most participants were unable to complete all 4 sessions of training, running larger future studies in longer-term treatment settings (such as rehabilitation) might lead to clearer results regarding whether VR-ABM has long-term benefits.
Based on these findings, we concluded that VR-ABM is safe and acceptable for most participants. However, it may not be best suited for delivery within a brief withdrawal admission. It may be more appropriate in longer‑term rehabilitation programs where there is more time to complete the training.
Project team
Turning Point team
Professor Victoria Manning, Doctor Joshua Garfield, Doctor Emily Colton, Marie Spehar, Mietta Bell
Project partners
This project was conducted in partnership with Uniting Vic Tas.
Funding
This project was supported by a National Health and Medical Research Council (NHMRC) Synergy grant number 2009851.